The Incidence of Diabetic Ketoacidosis During “Emerging Adulthood” in the USA and Canada: a Population-Based Study

Abstract

BACKGROUND: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication. OBJECTIVE: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood." DESIGN: Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013). PARTICIPANTS: Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba). MAIN MEASURES: DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization. KEY RESULTS: The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/ 10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/ 10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba. CONCLUSIONS: In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.

The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My!

“…We did not ask about interruptions in insurance, which has been linked to elevated A1C 31 and diabetic ketoacidosis. 32 Further research is needed to elicit safety related to underground exchange activities.…”

Glycaemic control in transition‐aged versus early adults with type 1 diabetes and the effect of a government‐funded insulin pump programme

“…A recent cross-sectional study comparing DKA hospitalization rates between type 1 diabetes people aged 15-17 versus 19-21 years in the United States and Manitoba, highlighted that organizational factors can be protective against DKA. 5 They reported that DKA hospitalization rates in those aged 15-17 versus 19-21 were 90% higher in the United States compared to only 23% higher in Manitoba. 5 They attributed this finding to differences in universal versus privately funded healthcare systems.…”

“…5 They reported that DKA hospitalization rates in those aged 15-17 versus 19-21 were 90% higher in the United States compared to only 23% higher in Manitoba. 5 They attributed this finding to differences in universal versus privately funded healthcare systems. While our study, conducted in a universal healthcare setting, also found that hyperglycaemia-related hospital visits were 50% higher in transition-aged compared to early adults, this risk difference was eliminated among those on governmentfunded CSII therapy.…”

“…1,2 Studies demonstrate that transition-aged adults with type 1 diabetes, typically categorized between the ages 18-24 years, are at heightened risk for non-adherence to routine care, poorer glycaemic control and increased rates of hospitalization for diabetes related events. [3][4][5] Data from the United States' T1D Exchange programme indicates that the average HbA 1c peaks between the ages of 18 and 25 years, with a peak mean value of 77 mmol/mol (9.2%) at around age 19. 6 Despite the greater adoption of technologies, such as continuous subcutaneous insulin infusion (CSII) therapy and continuous glucose monitoring systems, acute complication rates have not diminished over time in transition-aged adults with type 1 diabetes.…”

Virtual Group Appointments Reduce Distress and Improve Care Management in Young Adults with Type 1 Diabetes

“…By the time children and youth with chronic medical conditions reach young adulthood, they are less likely to graduate from high school or have a job; are more likely to lose health insurance coverage; and are more likely to receive Social Security, disability, or other federal assistance than their peers without chronic medical conditions. 6,7 For young adults (YA) with type 1 diabetes (T1D), the transition from pediatric to adult care is often associated with higher blood glucose levels, as patients manage intertwined physiological and psychosocial changes. 8 Fewer than onethird of YA with T1D meet self-care recommendations set forth by the American Diabetes Association, and only one in 7 meets the American Diabetes Association goal of attaining glycated hemoglobin (HbA1c) levels less than 7%.…”