Diabetic ketoacidosis at diagnosis of T1D in children is associated with high cost, higher long-term A1c, and complications. Due to delayed access to medical care, DKA in Colorado increased from 30% in 1998 to 46% in 2012. The rate in most developed countries is <30%. To examine a potential effect of the Affordable Care Act’s overhaul of the U.S. healthcare on the prevalence of DKA at diagnosis, we reviewed records of Colorado residents <18 years old who were diagnosed with T1D in 2010-17 and subsequently followed at the Barbara Davis Center for Diabetes. They account for >80% of children with T1D in Colorado. From 2010-2017, 2137 subjects met inclusion criteria. The rate of DKA rose from 40% to 60%, doubling among privately insured, but increased less among children with public insurance (Figure). In a univariate, unadjusted regression analysis, race/ethnicity other than non-Hispanic white (p<.01), public insurance (p<.0001), and rural residence (p=.02) were associated with higher risk for DKA. Gender and primary language other than English were not significantly associated with DKA. There was a bimodal distribution by age. By 2017, 60% of children presented with DKA. The increase was pronounced in patients with private insurance. This setback paradoxically occurred during a time of increasing health insurance coverage. More study needs to be done to understand what factors are driving these changes.

G.T. Alonso: None. A. Coakley: None. L. Pyle: None. K. Manseau: None. S. Thomas: None. M. Rewers: None. A. Rewers: None.

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