Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia

• Published in: Clinical endocrinology (Oxford) Vol. 81; no. 2; pp. 218 - 221
• Main Authors: Lewis, Kevin R., Clark, Crystal, Velarde, Maria C.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.08.2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Diabetes Mellitus, Type 1 - complications; Diabetes. Impaired glucose tolerance; Diabetic Ketoacidosis - etiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fundamental and applied biological sciences. Psychology; General aspects; Humans; Male; Medical sciences; Retrospective Studies; Socioeconomic Factors; Vertebrates: endocrinology; West Virginia; West Virginia; United States; North America; America; Endocrinopathy; Human; Pediatrics; Metabolic disorder; Socioeconomic status; Ketoacidosis; Diabetes mellitus; Cause; South; Acid base balance disorder; Child; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.12350

Summary Objective Diabetic Ketoacidosis (DKA) is a well‐known complication in children with type 1 diabetes mellitus (T1DM) with a mortality rate estimated at 2%. A previous study identified that T1DM children of non‐Caucasian race with Medicaid insurance had increased incidence of DKA admissions. The aim of this study is to identify the socioeconomic factors associated with DKA admissions in West Virginia (WV). Design and methods Retrospective chart review of patients admitted to the paediatric intensive care unit with DKA in Charleston, WV from January 2007–December 2010. Included subjects were 1–18 years of age and those with type 1 diabetes of >6 months duration. Admission rates were compared with the normal population distribution in WV. The data collection tool included multiple socioeconomic factors and HbA1c. Results We reviewed a total of 167 patients with an admitting diagnosis of DKA; 57% were female, 43% male. Average age was 13·5 years ± 2·7; 56·4% were covered by Medicaid/Chips (WV state insurance) and 43·6% by commercial payers. 11·9% were African American and 88·1% were Caucasian. The average HbA1c was 10·85 ± 2·36%. Higher risks for DKA included those with HbA1c >14%, African American children (OR 17·4, CI 4–73) and children with Medicaid/Chips insurance (OR 9·3, 95% CI 1·1–76·2). Conclusions This study identifies socioeconomic factors associated with children admitted for DKA in WV. Patients at higher risk for DKA include those with elevated HbA1c, African American race and those covered by Medicaid/CHIPS (thereby presumed lower socioeconomic status). Findings can be utilized to identify patients at highest risk for DKA and implementation of prevention strategies.