Background: Rates of diabetic ketoacidosis (DKA) have been rising despite many medical advances. National studies in the U.S. describe higher rates in younger populations, although studies have not closely characterized U.S. trends in pediatrics.
Methods: We conducted a study using the national Kids’ Inpatient Database to identify pediatric admissions for DKA in years 2006, 2009, 2012, and 2016. Newborn admissions were excluded. We used descriptive statistics to describe prevalence of DKA admissions, DKA rates and trends among all pediatric admissions. Logistic regression was used to evaluate differences in DKA rates overtime within subgroups and determine factors associated with DKA trends.
Results: We identified 12,271,107 admissions of which 149,713 were for DKA. Among those with DKA, there was a high prevalence of those 15-20yo (58%), female sex (54%), white race (50%), and publicly insured (44%). Most were from urban areas (81%), the bottom two income quartiles (58%) and hospitalized in large (60%), private hospitals (71%), and in southern states (40%). When compared to all pediatric admissions, rates of DKA were highest in those 12-14yo, of male sex, black race, second income quartile and with charity care. Patients from non-urban areas and those hospitalized in private and small hospitals also had higher rates. There was a large rise in DKA admissions rates per 10,000 admissions from 94.6 in 2006 to 184.6 in 2016. The rate of change was similar within most subgroups. The characteristics positively associated with DKA admission after adjustment were age 12-14yo, male sex, black race, publicly insured or self-pay, lower income, and hospitals that were private, small, or located outside the northeast.
Conclusions: Rates of DKA admission have increased from 2006 to 2016. Although there were disparities among subgroups admitted, the rise in rate overtime was similar within most subgroups. Further studies are needed to understand drivers of admission in this population.
E.M. Everett: None. T. Copeland: None. T. Moin: None. L.E. Wisk: None.
National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01)