Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

Desai, Dimpi; Mehta, Dhruv; Mathias, Priyanka; Menon, Gopal; Schubart, Ulrich K.

doi:10.2337/dc17-1379

Cited by 150 publications

(129 citation statements)

References 32 publications

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“…The Austrian campaign took 20 years to attain a 13% decrease in the DKA incidence at diabetes onset in paediatric age 14. Recent data from the USA showed a steadily increasing incidence of DKA in both children and adults, but associated with a decrease in DKA-associated mortality 16. Moreover, it is interesting to note that a recent systematic review of publicity interventions to increase awareness among healthcare professionals and the public to promote earlier diagnosis of type 1 diabetes in children and young people does not reach a definitive conclusion on the effectiveness of the interventions reported 17…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

et al. 2019

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ObjectiveAfter a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013–2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign.DesignProspective observational study.SettingMulticentre study throughout Italy.InterventionNational awareness campaign started in November 2015 and held until December 2017.PatientsDuring 2016 and 2017 we collected data on all patients aged 0–18 years with new-onset diabetes.Main outcome measuresDKA (pH <7.30), severe DKA (pH <7.1), DKA in children below 6 years and DKA treatment according to the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) protocol were evaluated.ResultsRecords (n=2361) of children with newly diagnosed type 1 diabetes were collected from 58 out of 68 (85.3%) centres of the original survey participants and 100% of the previously surveyed tertiary centres. Overall, DKA was observed in 1124 patients, with an increased rate when compared with the previous survey (47.6% vs 38.5%, p=0.002), and severe DKA in 15.3%. In children below 6 years, DKA was observed in 323 out of 617 (52.5%) and severe DKA in 16.7%; in this age group, occurrence of DKA reduced by 21.3% (p=0.009). DKA treatment according to the ISPED guidelines was adopted in 95% of the centres, with a 27% improvement (p=0.025).ConclusionsDuring a 2-year awareness campaign, DKA at onset of diabetes in children and adolescents 0–18 years is still common and increased when compared with the 2013–2014 survey.

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Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

et al. 2019

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“…idence of continuous interstitial glucose monitoring demonstrating fatal nocturnal hypoglycaemia [5]. Although in a nationwide U.S. analysis diabetic ketoacidosis (DKA) showed a significant reduction in mortality during 2003-2014, there was still an in-hospital mortality of 0.4 % [6]. It has been estimated that 15 % up to nearly one third of cases of deaths due to severe hyperglycaemia or DKA occur in individuals with so far unknown diabetes [7,8].…”

Section: Introductionmentioning

confidence: 99%

Postmortem Analysis of Vitreous Humor For Detection of Antemortem Disorders in Glucose Metabolism. An Old Method Revisited

Holstein¹,

Titze

Heß

2018

Exp Clin Endocrinol Diabetes

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It has been estimated that 15% up to one third of cases of deaths due to diabetic ketoacidosis occur in individuals with so far unknown diabetes. Moreover, cardiac arrhythmias that occur during nocturnal hypoglycaemia include bradycardia and ectopics that may provoke lethal arrhythmias. As postmortem capillary glucose concentrations have no diagnostic value, the postmortem forensic proof of hyperglycaemia or hypoglycaemia remains a challenge. The established but rarely applied method of postmortem determination of glucose and lactate in vitreous humor with or without calculation of the sum formula of Traub could provide reliable exclusion or proof of severe antemortem disorders in glucose metabolism. To date, diagnostic puncture of vitreous humor is more established for the postmortem detection of diabetic ketoacidosis than for the exclusion or proof of lethal hypoglycaemia. Vitreous humor is protected from postmortem degradation and contamination due to its isolated localization. The autolytic process in vitreous humor is considerably delayed compared to blood or liquor. In vitreous humor also the triggering agent of hypoglycaemia (insulin, insulin analogues) is easier to be detected than in blood since insulins are very unstable in postmortem blood. Furthermore, parameters of long term glycaemic control such as 1,5-anhydroglucitol, HbA1c and fructosamine can be determined in vitreous humor. However, limitations and interference factors of this method should be carefully considered. So far, clinical diabetology has taken no broad notice of this useful forensic procedure.

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“…In conclusion, we congratulate Desai et al (1) for their great contribution to our current knowledge on DKA in the U.S. and encourage them to provide an updated hospital cost analysis. Thus, researchers and health care policy experts can plan future studies and programs based on the actual health care utilization burden for DKA in the U.S.…”

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confidence: 83%

Comment on Desai et al. Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis. Diabetes Care 2018;41:1631–1638

2019

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We read with great interest the outstanding study by Desai et al. (1) in the recent issue of Diabetes Care. The authors aimed to determine the incidence and costs of hospitalizations for diabetes ketoacidosis (DKA) in the U.S. The authors searched the National Inpatient Sample (NIS) database for all DKA admissions during 2003-2014. Consistent with recent Centers for Disease Control and Prevention reports (2), the study confirmed a decrease in hospital mortality but a significant increase in the number of hospitalizations for DKA. Notably, they reported a significant increase (56%) in the "inflation-adjusted hospital charges" for DKA admissions, from $18,987 in 2003 to $26,566 in 2014 (P , 0.001). Thus, the inflation-adjusted "national bill" for DKA hospitalization was estimated to be $5.1 billion in 2014. It is noteworthy that the authors used the terms "charges" and "costs" interchangeably in the abstract and article. Extensive evidence supports that hospital charges should not be used as a direct estimate of the cost of hospital care (3-5). For instance, hospital charges, defined as the amount billed by hospitals for the services rendered, do not actually reflect hospital costs, defined as how much the hospital service actually costs or was paid to the hospital. Hospital costs are the actual expenses incurred by hospitals in rendering the service, including wages, supplies, and utility

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Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

Cited by 150 publications

References 32 publications

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

Postmortem Analysis of Vitreous Humor For Detection of Antemortem Disorders in Glucose Metabolism. An Old Method Revisited

Comment on Desai et al. Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis. Diabetes Care 2018;41:1631–1638

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