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Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Colorado Children, 2010-2017.
Diabetes Care ( IF 16.2 ) Pub Date : 2019-10-10 , DOI: 10.2337/dc19-0428
G Todd Alonso 1 , Alex Coakley 2 , Laura Pyle 2, 3 , Katherine Manseau 4 , Sarah Thomas 2 , Arleta Rewers 5
Affiliation  

OBJECTIVE We examined trends in diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes at a large pediatric diabetes center between 2010 and 2017, overlapping with the Affordable Care Act's overhaul of U.S. health care. RESEARCH DESIGN AND METHODS Colorado residents <18 years old who were diagnosed with type 1 diabetes from 2010 to 2017 and subsequently followed at the Barbara Davis Center for Diabetes were included. Logistic regression models were used to test associations among age, sex, race/ethnicity, insurance, language, year of diagnosis, and rural/nonrural residence and DKA at diagnosis. Linear regression models were used to test the association of each predictor with HbA1c at diagnosis. RESULTS There were 2,429 subjects who met the inclusion criteria. From 2010 to 2017, the rate of DKA increased from 41 to 58%. It increased from 35.3 to 59.6% among patients with private insurance (odds ratio 1.10 [95% CI 1.05-1.15]; P < 0.0001) but remained unchanged (52.2-58.8%) among children with public insurance (1.03 [0.97-1.09]; P = 0.36). In the multivariable model, public insurance (1.33 [1.08-1.64]; P = 0.007), rural address (1.42 [1.08-1.86]; P = 0.013), and HbA1c (1.32 [1.26-1.38]; P < 0.0001) were positively associated with DKA, whereas age, race/ethnicity, sex, and primary language were not. CONCLUSIONS The increase in the rate of DKA in patients with newly diagnosed type 1 diabetes was driven by patients with private insurance. This paradoxically occurred during a time of increasing health insurance coverage. More study is needed to understand the factors driving these changes.

中文翻译:

2010-2017年在科罗拉多州儿童诊断1型糖尿病中的糖尿病酮症酸中毒。

目的我们研究了2010年至2017年间大型儿童糖尿病中心在诊断1型糖尿病时的糖尿病酮症酸中毒(DKA)的趋势,以及《经济适用医疗法案》对美国医疗保健的全面改革。研究设计与方法研究对象包括2010年至2017年被诊断患有1型糖尿病并随后在芭芭拉戴维斯糖尿病中心接受随访的18岁以下科罗拉多州居民。使用Logistic回归模型测试年龄,性别,种族/民族,保险,语言,诊断年份以及诊断时的农村/非农村居民和DKA之间的关联。在诊断时,使用线性回归模型来检验每个预测因子与HbA1c的关联。结果有2429名符合纳入标准的受试者。从2010年到2017年,DKA的比例从41%上升到58%。私人保险患者的比率从35.3增加到59.6%(赔率1.10 [95%CI 1.05-1.15]; P <0.0001),但在公共保险儿童中则保持不变(52.2-58.8%)(1.03 [0.97-1.09]) ; P = 0.36)。在多变量模型中,公共保险(1.33 [1.08-1.64]; P = 0.007),农村地址(1.42 [1.08-1.86]; P = 0.013)和HbA1c(1.32 [1.26-1.38]; P <0.0001)为与DKA呈正相关,而年龄,种族/民族,性​​别和主要语言则不相关。结论新诊断的1型糖尿病患者中DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。10 [95%CI 1.05-1.15];P <0.0001),但在有公共保险的儿童中保持不变(52.2-58.8%)(1.03 [0.97-1.09]; P = 0.36)。在多变量模型中,公共保险(1.33 [1.08-1.64]; P = 0.007),农村地址(1.42 [1.08-1.86]; P = 0.013)和HbA1c(1.32 [1.26-1.38]; P <0.0001)为与DKA呈正相关,而年龄,种族/民族,性​​别和主要语言则不相关。结论新诊断的1型糖尿病患者中DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。10 [95%CI 1.05-1.15];P <0.0001),但在有公共保险的儿童中保持不变(52.2-58.8%)(1.03 [0.97-1.09]; P = 0.36)。在多变量模型中,公共保险(1.33 [1.08-1.64]; P = 0.007),农村地址(1.42 [1.08-1.86]; P = 0.013)和HbA1c(1.32 [1.26-1.38]; P <0.0001)为与DKA呈正相关,而年龄,种族/民族,性​​别和主要语言则不相关。结论新诊断的1型糖尿病患者DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。在多变量模型中,公共保险(1.33 [1.08-1.64]; P = 0.007),农村地址(1.42 [1.08-1.86]; P = 0.013)和HbA1c(1.32 [1.26-1.38]; P <0.0001)为与DKA呈正相关,而年龄,种族/民族,性​​别和主要语言则不相关。结论新诊断的1型糖尿病患者中DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。在多变量模型中,公共保险(1.33 [1.08-1.64]; P = 0.007),农村地址(1.42 [1.08-1.86]; P = 0.013)和HbA1c(1.32 [1.26-1.38]; P <0.0001)为与DKA呈正相关,而年龄,种族/民族,性​​别和主要语言则不相关。结论新诊断的1型糖尿病患者中DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。结论新诊断的1型糖尿病患者DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。结论新诊断的1型糖尿病患者中DKA发生率的增加是由私人保险患者推动的。这自相矛盾地发生在健康保险覆盖面不断扩大的时期。需要更多的研究来了解驱动这些变化的因素。
更新日期:2019-12-21
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