Background
Diabetic ketoacidosis (DKA) is a well-known complication in children with Type 1 diabetes, with a mortality rate estimated at 2%. Sparse data are available from the literature describing the sociodemographic factors associated with DKA admissions in children. A previous study identified that children with Type 1 diabetes who are of non-Caucasian race and those with Medicaid had increased incidence of DKA admissions.
Aims
The aim of this study was to identify the sociodemographic factors associated with DKA admissions including type of insurance coverage, income by county, race, gender, and HbA1c in West Virginia, a primarily rural part of Appalachia.
Methods
A retrospective chart review was conducted of patients, aged 1 to 18 years, with known Type 1 diabetes with DKA admitted to the pediatric intensive care unit (PICU) at Women and Children's Hospital in Charleston, WV, from January 2007 to December 2010 in comparison with our general Type 1 diabetes population. The data collection tool included multiple sociodemographic factors, HbA1c, and markers of the degree of DKA.
Results
We reviewed a total of 167 patients with an admitting diagnosis of DKA; 63 charts were excluded because they did not meet either DKA criteria and age criteria, had new-onset diabetes, or lived outside of West Virginia; 57% were female, 43% male. Average age was 13.6 years (SD = 2.81 years); 56% were covered by Medicaid or CHIPS insurance and 44% by commercial payers; 11.5% were African American and 88.5% were Caucasian. The average HbA1c was 10.85% (SD = 2.364). Average length of stay in the PICU was 17.8 hours (SD = 11.13). We identified peak DKA admissions during April to October, with the lowest admissions being December through March.
Conclusions
Salient findings include higher HbA1c and higher rates in African American patients and in those covered by Medicaid/CHIPS.
Clinical Implications
This study identifies sociodemographic factors associated with children admitted for DKA in West Virginia. Patients indentified to be at higher risk for DKA include those with elevated HbA1c, of African American race, and covered by Medicaid/CHIPS. Nurses can utilize these findings to develop strategies to educate these high-risk groups on the prevention of DKA.
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Copyright
© 2012 Published by Elsevier Inc.
