Lowering the Risk of Diabetic Ketoacidosis in Young Patients

Patients who were seen at an emergency department had an increased likelihood of diabetic ketoacidosis during the next 14 days.

Management of type 1 diabetes mellitus (T1DM) is a full-time job, and in addition to the day-to-day management, T1DM patients face a higher risk of diabetic ketoacidosis (DKA), the primary cause of morbidity and mortality among children with T1DM.

A new study published in the June 2016 Journal of Pediatrics indicated that recent emergency department (ED) visits and missed quarterly endocrinologist appointments could help predict DKA hospitalizations.

Researchers from the Stanford University School of Medicine conducted a retrospective analysis of children with T1DM enrolled in California Children’s Services (CCS), a form of Medicaid. The study reviewed paid claims for 5263 enrolled children from 2009 to 2012 for exposure to 2 types of outpatient care: (1) maintenance care and (2) acute care.

Of those enrolled, 878 (16.7%) children were hospitalized during the study period. A novel finding in this study was that patients who were seen at an ED had an increased likelihood of DKA during the next 14 days.

This suggested that timely outpatient appointments should be made to prevent possible hospitalization. The second major finding was that patients who had missed a quarterly endocrinology visit (within the last 120 days) had a higher risk of DKA hospitalization.

This finding supports a 1997 study by the Joslin Diabetes Center and shows a need of future research in different patient populations to strengthen the associations. The author suggested that more than 50% of diabetic children were not meeting the recommendation for quarterly subspecialty care for various reasons.

Missed appointments should trigger management strategies aimed to prevent DKA, such as renewed education, care coordination, and patient- or family-focused behavioral interventions. The team acknowledged that further research into the role of outpatient care and the prevention of DKA is needed to verify their findings and to provide guidelines that will improve care and outcomes for these patients.