Multinational analysis shows diabetic ketoacidosis (DKA) rates still high among pediatric patients

In the largest multinational analysis of diabetic ketoacidosis (DKA) in pediatric type 1 diabetes patients DZD scientists found in cooperation with T1D Exchange researchers consistently high rates and common risk factors for DKA across five countries, confirming that DKA – a largely preventable condition – remains a serious threat for type 1 diabetes patients. The analysis also highlights the considerable costs associated with treating DKA, which creates a serious financial burden for healthcare systems, patients and families.

Researchers examined data from nearly 50,000 pediatric type 1 diabetes patients ages two through 18 via three massive databases: the T1D Exchange Clinic Registry, the most comprehensive type 1 diabetes database in the U.S., comprising more than 27,000 patients from 76 pediatric and adult endocrinology centers; the Diabetes Prospective Follow-up (DPV) registry, which has more than 40,000 patients from 209 centers in Germany and Austria; and the National Paediatric Diabetes Audit (NPDA) of nearly 16,350 patients who attend pediatric diabetes units in England and Wales.

According to the paper, published online today in Diabetes Care and forthcoming in the October issue, the frequency of DKA ranged from five to seven percent of pediatric patients diagnosed and treated each year across the three registries, or:
• One in 14 in the U.S. (T1D Exchange Clinic Registry);
• One in 16 in England and Wales (NPDA); and
• One in 20 in Germany and Austria (DPV).

Patients in all three registries also exhibited common risk factors for DKA diagnosis:
• Female gender: 23 percent higher odds of DKA than males;
• Ethnic minorities: 27 percent higher odds than non-ethnic minorities; and
• Elevated HbA1c levels: Patients with HbA1c levels 7.5 percent or higher had the greatest odds for DKA.

“Diabetic ketoacidosis is a life-threatening complication, with rates continuing to be much too high among children with type 1 diabetes. It is especially concerning to see such high rates in developed countries that have sophisticated, advanced healthcare systems. Clearly, we need better education and prevention programs specifically targeted toward families,” said principal investigator David M. Maahs, MD, PhD, a T1D Exchange researcher and associate professor of pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado. 

Diabetic ketoacidosis results from a shortage of insulin; in response, the body breaks down fat and muscle for energy, releasing ketones, which are acidic, into the bloodstream, causing the chemical imbalance that leads to diabetic ketoacidosis. DKA can largely be prevented by adhering to strict diabetes management, including monitoring blood glucose, checking urine or blood to identify ketosis early on and adjusting insulin levels as needed.
If left untreated, patients with DKA often require expensive emergency medical care. According to the researchers, from 2004-2009 in the U.S., the mean hospital cost per pediatric DKA admission was approximately $7,100. Further, insurance claims data indicate $5,837 in additional annual medical expenditures for pediatric type 1 patients with DKA compared with those without DKA. In Germany, pediatric diabetes patients with DKA had nearly four-fold higher diabetes costs than those without DKA.

More than 12,700 pediatric patients in the U.S. are diagnosed with DKA each year; researchers estimate the annual total cost of treating these pediatric DKA cases is approximately $90 million. Eliminating just 10 percent of these cases (approximately 1,200 patients) could result in a potential savings of $9 million per year.

“The costs associated with treating diabetic ketoacidosis are significant, especially for pediatric patients who often wind up in intensive care units following diagnosis,” said Maahs. “The economic incentive to establishing DKA education and prevention programs is huge. Not only would these programs produce better patient outcomes, but they can potentially drive down costs in already overburdened healthcare systems and families.”

International Type 1 Diabetes Assessments, Establishing Benchmarks
The study is one of several joint initiatives between T1D Exchange and the DPV and NPDA registries. In addition to examining the rates and risk factors of DKA across the five countries, the analysis also sought to identify and understand where to target interventions in order to improve quality of care for the global type 1 diabetes community.

“Benchmarking these data is an important part of research and collaboration. Such comparisons allow researchers and clinicians worldwide to identify issues facing the patient community; what patients need most; and where to deploy resources and research in order to improve standards of care in diabetes treatment and management,” said Henry Anhalt, DO, chief medical officer at T1D Exchange.

T1D Exchange, the first program of Unitio, was founded on the premise that finding faster, better therapies for type 1 diabetes (T1D) requires a research model as multi-faceted as the disease itself. T1D Exchange acts as a convener of the thousands of people working to improve patient outcomes already—by connecting them to one another and to the patient community at large. Drawing on decades of research and data that have come before, T1D Exchange aims to be the translational engine that enables the entire T1D ecosystem to collaborate in truly novel ways via the integration of a Clinic Network, Clinic Registry, Biobank, and the online patient/caregiver community, Glu.
The study was funded by The Leona M. and Harry B. Helmsley Charitable Trust, the German BMBF Competence Network Diabetes Mellitus (which is integrated into the German Center for Diabetes Research (DZD) as of January 2015), the Healthcare Quality Improvement Partnership (HQIP) and delivered by the Royal College of Paediatrics and Child Health (RCPCH)