Medical Costs Significantly Higher for Youth With DKA at Time of Diabetes Diagnosis

An African American mother is holding her young daughter on her lap. The child is having an appointment at a medical clinic. They are seated at a table across from the medical professional. The ethnic male doctor is teaching the mother and daughter about diabetes and how to use an insulin pen.
Use of healthcare services and medical costs within 60 days of diabetes diagnosis are higher for youth with diabetic ketoacidosis.

Use of healthcare services and medical costs within 60 days of diabetes diagnosis are higher for youth with diabetic ketoacidosis (DKA), according to study results published in Diabetes Care.

Investigators analyzed data from the United States MarketScan Commercial Claims and Encounters database for youth aged 3 to 19 years who were privately insured and newly diagnosed with diabetes between 2010 and 2016. Youth with and without DKA at diabetes diagnosis were compared for measures of mean outpatient, inpatient, and emergency room care and medical costs for 60 days prior to and 60 days after diabetes diagnosis. Costs were adjusted to 2016 US dollars.

Of 4889 patients identified, 42.9% (n=2099) had DKA near the time of diabetes diagnosis. In the 60 days prior to diabetes diagnosis, youth with DKA at diagnosis used health services less frequently and had lower total medical costs (-$625) compared with youth without DKA at diagnosis. However, in the 60 days after diagnosis, youth with DKA had significantly higher healthcare costs (+$6652) and averaged 0.34 more office visits, 0.35 more inpatient admissions, and 0.49 more days in the hospital compared with youth without DKA.

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The study was limited by reliance on International Classification of Diseases codes to determine cases of DKA, a study population limited to youth with private insurance, lack of distinction between type 1 and type 2 diabetes, and no access to additional socioeconomic data as race/ethnicity or household income.

“Given 23,200 annual incident cases of diabetes among youth in the U.S., and assuming 30–40% of these cases present with DKA at diabetes diagnosis, annual excess medical costs could range from $46 million to $63 million,” investigators wrote. “These costs could potentially be avoided if DKA is averted through timely diabetes diagnosis and management.”

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Saydah SH, Shrestha SS, Zhang P, Zhou X, Imperatore G. Medical costs among youth younger than 20 years of age with and without diabetic ketoacidosis at the time of diabetes diagnosis [published online October 1, 2019]. Diabetes Care. doi:10.2337/dc19-1041