Pediatric Diabetic Ketoacidosis Management in the Era of Standardization

Ildiko H Koves; Catherine Pihoker


Expert Rev Endocrinol Metab. 2012;7(4):433-443. 

In This Article


Medical expenditure for this potentially entirely preventable complication of T1DM in youth is substantial and imposes a large economical burden on the healthcare system. Despite substantial progress in overall diabetes management and care over the past few decades, the incidence of DKA remains high.[9,17,24] Simple tools such as posters at schools and pediatricians' offices during the historical Parma campaign have reduced the cumulative frequency of moderate and severe DKA over an 8-year time period from 78 to 12.5%. The poster raised awareness of new-onset enuresis that may indicate diabetes mellitus onset and has led to cost saving of approximately US$24,000.[23] Among the privately insured youth, the mean annual total medical expenditure in the USA during 2007 was approximately $14,000 per person.[59] The burden of costs associated with the un- or under-insured is likely to be much higher as the incidence of DKA is higher.[60] A multidisciplinary structured approach with behavioral intervention to their management has been shown to lead to reduced rates of DKA admission, which translate to cost savings and, more importantly, decreased morbidity for these young patients.

Numerous publications[46,61–63] have shown that the use of home ketone testing, with BOHB measurements with the available Precision Xtra® (Abbott Laboratories), Nova Max Plus® (Nova Biomedical), Menarini home glucose meters, may significantly reduce the need for emergency department presentations and hospitalizations for DKA. Home measurement of BOHB may be particularly useful in preventing DKA-related presentation for the increasing number of patients on continuous subcutaneous insulin infusion therapy. Unfortunately, in the USA, insurance companies often do not subsidize the use of the ketone testing strips, resulting in a substantial financial burden, direct out of pocket costs to the families and secondarily increased financial burden on the health system due to late recognition of ketonemia and high frequency of DKA presentations with its associated morbidity and mortality.

Overall, the average cost of a hospitalization for DKA is US$13,000 per (pediatric or adult) patient, resulting in a total cost of over US$1 billion annually in the USA.[64]


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