Medical Costs Among Youth Younger Than 20 Years of Age With and Without Diabetic Ketoacidosis at the Time of Diabetes Diagnosis

Abstract

Objective: While diabetic ketoacidosis (DKA) is common in youth at the onset of the diabetes, the excess costs associated with DKA are unknown. We aimed to quantify the health care services use and medical care costs related to the presence of DKA at diagnosis of diabetes.

Research design and methods: We analyzed data from the U.S. MarketScan claims database for 4,988 enrollees aged 3-19 years insured in private fee-for-service plans and newly diagnosed with diabetes during 2010-2016. Youth with and without DKA at diabetes diagnosis were compared for mean health care service use (outpatient, office, emergency room, and inpatient visits) and medical costs (outpatient, inpatient, prescription drugs, and total) for 60 days prior to and 60 days after diabetes diagnosis. A two-part model using generalized linear regression and logistic regression was used to estimate medical costs, controlling for age, sex, rurality, health plan, year, presence of hypoglycemia, and chronic pulmonary condition. All costs were adjusted to 2016 dollars.

Results: At diabetes diagnosis, 42% of youth had DKA. In the 60 days prior to diabetes diagnosis, youth with DKA at diagnosis had less health services usage (e.g., number of outpatient visits: -1.17; P < 0.001) and lower total medical costs (-$635; P < 0.001) compared with youth without DKA at diagnosis. In the 60 days after diagnosis, youth with DKA had significantly greater health care services use and health care costs ($6,522) compared with those without DKA.

Conclusions: Among youth with newly diagnosed diabetes, DKA at diagnosis is associated with significantly higher use of health care services and medical costs.

Figure 1—

Sample selection for youth <20 years of age with newly diagnosed diabetes in MarketScan, 2010–2016. 1: Number of enrollees in any health plan with length of enrollment >1 day, during 1 January 2010 to 31 December 2016. 2: First diagnosed with diabetes during the period using the algorithm described. 3: Those with age at diagnosis younger than 20 years. 4: Those with continuous enrollment in any health plan 2 years before and 1 year after the diabetes diagnosis. 5: Excluding those who had prescription drug claims for antidiabetes medications before the diagnosis date (Therapeutic class codes 172, 173, and 174). 6: Newly diagnosed with diabetes, excluding those with gestational diabetes mellitus (GDM) before the diagnosis. 7: Excluding those with history of acute and chronic pancreatitis. 8: Excluding those diagnosed with DKA >7 days after diabetes diagnosis. 9: Excluding those with history of chronic conditions, n = 196. Chronic conditions include: congestive heart failure, hemiplegia, HIV/AIDS, any malignancy (including lymphoma and leukemia, except malignant neoplasm of skin), mild liver disease, peripheral vascular disease, renal disease, rheumatic disease, cerebrovascular disease, metastatic solid tumor, and peptic ulcer. 10: Those enrolled in FFS or capitated plans. 11: Those with DKA at diabetes diagnosis (within 7 days). RX, prescription.