Young Children in Medicaid have More Diabetes Complications

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The rate of ketoacidosis among children younger than 5 years of age with type 1 diabetes is higher in Medicaid than commercial plans, finds new analysis.

Children younger than 5 years of age who have type 1 diabetes and in Medicaid programs experienced higher rates of ketoacidosis than children in commercial insurance plans, according to a poster presented at the recent annual meeting of the Academy of Managed Care Pharmacy in New Orleans.

In fact, more than 12 months after diagnosis, diabetic ketoacidosis (DKA) events were 2.5 times higher in children who have Medicaid coverage. “This suggests an increased DKA-related clinical and HRU (healthcare resource utilization) burden for T1D management in patients who used Medicaid,” the investigators wrote.

About 352,000 children and adolescents younger than age 20 years have been diagnosed diabetes, includes 304,000 with type 1 diabetes, according to data from the CDC.

Diabetic ketoacidosis is a serious complication of diabetes. Without enough insulin, cells are not able to use sugar for energy. The liver will begin to break down fat for fuel, which produces acids called ketones. In children with established diabetes, diabetic ketoacidosis occurs at rates of 6% to 8% percent per year, according to recent data.

This retrospective analysis, sponsored by Sanofi, assessed the use of healthcare resources of children with type 1 diabetes after diagnosis. Researchers analyzed pediatric patients with newly diagnosed type 1 diabetes from Jan. 1, 2015, to June 30, 2018, using data from Merative MarketScan, a data and analytics company.

Patients with at least two medical claims with a type 1 diabetes code were included. Use of healthcare resources were analyzed based on type of health plan: commercial or Medicaid. Researchers assessed 5,245 patients, of which 4,092 were in commercial plans and 1,153 were in Medicaid. Baseline comorbidities overall were low, but those in Medicaid plans had greater comorbidities. Researchers did not say what those comorbidities were.

Medicaid patients where were 0- to 5-yr-old experienced diabetic ketoacidosis less than or equal to three months after initial clinical diagnosis. Additionally, more children with experienced diabetic ketoacidosis 12 months or later after diagnosis. They also experienced more emergency department visits and hospitalizations than those with commercial insurance.

Previous research has found that children covered by Medicaid admitted to hospitals with diabetic ketoacidosis had longer hospitalizations, more procedures performed, and higher total costs of care.

Another study found that hospitalization overall for children with diabetic ketoacidosis had grown 40% over the decade from 2006 to 2016. This study suggested additional research to look at the psychosocial and financial factors that drive the risk for diabetic ketoacidosis so that clinical interventions can be determined to address the risk.

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