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DOI: 10.1055/s-0032-1312639
Frequency and Cost of Diabetic Ketoacidosis in Germany – Study in 12 001 Paediatric Patients
Publication History
received 19 April 2012
first decision 19 April 2012
accepted 25 April 2012
Publication Date:
11 June 2012 (online)
Abstract
Aims:
Recently, medical expenditures were found to be 2-fold increased in paediatric patients with diabetic ketoacidotic events (DKA) in the U.S., in particular due to hospitalization. Aim of our study was to analyse DKAs and associated costs in Germany, where structured diabetes care including education is available for all patients.
Methods:
For all 12 001 diabetic patients 0–19 years of age (52.6% male, mean age (SD) 12.6 (3.9) years) documented in a German-wide database, all DKAs were assessed, as well as costs for diabetes-related treatment. Associations between costs and DKA were estimated using log-linear models.
Results:
457 (3.8%) patients had at least 1 DKA during 2007. Total annual costs for patients without, with 1, or ≥ 2 DKAs were € 3 330 (95%-CI 3 292–3 368), € 6 935 (CI 6 627–7 244), and € 10 728 (CI 9 813–11 644), respectively, with largest differences for hospitalization costs (€ 693, € 4 145, € 8 092). Age-sex-diabetes duration-adjusted cost ratios for patients with 1, or ≥ 2 DKAs compared to patients without DKA were 2.2 (CI 2.1–2.3) and 3.6 (CI 3.1–4.1), respectively.
Conclusions:
In Germany, paediatric diabetic patients with DKA had up to 3.6-fold higher diabetes-related costs compared to those without DKA. This cost excess was higher compared to a U.S. study, however, the proportion of patients with DKA was much lower (3.8% versus 14.9%). The lower frequency of DKA in Germany may be due to a higher access to and utilization of diabetes education. Interventions should reduce DKA and resulting hospital admission in pediatric patients in order to reduce costs and improve quality of life.
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References
- 1 Shrestha SS, Zhang P, Barker L et al. Medical expenditures associated with diabetes acute complications in privately insured U.S. youth. Diabetes Care 2010; 33: 2617-2622
- 2 Icks A, Rosenbauer J, Straßburger K et al. for the DPV Wiss Initiative . Persistent significant social disparities in hospitalization risk for pediatric diabetes patients in Germany – prospective data from 1 277 diabetic children and adolescents. Diabet Med 2007; 24: 440-442
- 3 Icks A, Rosenbauer J, Holl RW et al. Hospitalization among diabetic children and adolescents and the general population in Germany. German Working Group for Pediatric Diabetology. Diabetes Care 2001; 24: 435-440
- 4 Karges B, Kapellen T, Neu A et al. for the Diabetes Prospective Documentation (DPV) Initiative and the German Federal Ministry for Education and Research (BMBF) Competence Network of Diabetes Mellitus . Long-acting insulin analogs and the risk of diabetic ketoacidosis in children and adolescents with type 1 diabetes: a prospective study of 10 682 patients from 271 institutions. Diabetes Care 2010; 33: 1031-1033
- 5 Bächle C, Holl RW, Straßburger K et al. for the DPV Initiative and the German BMBF Competence Network Diabetes mellitus . Costs of paediatric diabetes care in Germany: current situation and comparison to the year 2000. Diabetic Medicine (in press)