Socio-demographic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia
K. Lewis1, S. Bendre1, C. Clark3 & D. Wiley2
Background: Diabetic ketoacidosis (DKA) is a well-known complication in children with type 1 diabetes (T1DM) with a mortality rate estimated at 2%. Sparse data are available from the literature describing socio-demographic factors associated with DKA admissions in children. A previous study identified that children of non-Caucasian race and Medicaid, with T1DM, had increased incidence of DKA admissions.
Aims: To identify the socio-demographic factors associated with DKA admissions including type of insurance coverage, income by county, race, gender and HbA1c in West Virginia, a rural part of Appalachia.
Methods: A retrospective chart review of patients with known type 1 diabetes ages 118 years admitted to the Pediatric ICU with DKA in Charleston WV from January 2007 to December 2010 in comparison to our general type 1 diabetes population. The data collection tool included multiple socio-demographic factors and HbA1c.
Results: We reviewed a total of 167 patients with an admitting diagnosis of DKA; 63 charts were excluded because they did not meet either DKA criteria, age criteria, had new onset diabetes or lived outside of WV. About 57% were female, 43% male. Average age was 13.6 years (S.D.±2.81) 56% were covered by Medicaid or Chips insurance and 44% by commercial payers. About 11.5% were African American and 88.5% were Caucasian. The average HbA1c was 10.85% (S.D.±2.364).
Conclusions: Salient findings include higher HbA1c, higher rates in African American patients and in those covered by Medicaid.
Clinical implications: This study identifies socio-demographic factors associated with children admitted for DKA in WV. Patients identified at higher risk for DKA include those with elevated HbA1c, African American race and those covered by Medicaid/CHIPS. Findings can be utilized to identify patients at higher risks for DKA and implementation of prevention strategies.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.