558 - Changes in the Epidemiology and Outcomes of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State in Pediatric Patients from 2017-2024: a PHIS Database Study

Publication Number: 1537.558

Nevin R. Walia, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Steven L. Shein, Children's National Health System, Washington, DC, United States; Richard Speicher, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) are severe and potentially lethal complications of diabetes mellitus (DM) commonly seen in the Pediatric ICU (PICU). Most available epidemiologic data are >10-20 years old, and the field is in need of more current insights as both COVID-19 and the introduction of GLP-1 agonists could have shifted the trends in the epidemiology and outcomes of these conditions.

Objective: We aimed to report trends in the epidemiology and outcomes of PICU DKA/HHS from 2017-2024.

Design/Methods: With IRB approval, we conducted a database study using the Pediatric Health Information System (PHIS) of patients < 19 years old between 2017-2024 with an ICU flag and ICD-10 diagnosis of DKA or HHS secondary to Type 1 or Type 2 DM. Only hospitals contributing data in all study years were included. Demographics, PICU length of stay (LOS), presence of a Complex Chronic Condition flag, mortality and billing data for select interventions were compared between study years using chi-squared (categorical data), Wilcoxon rank-sum (continuous data; shown as median [IQR]) and linear regression (binary variables; shown as linear coefficient β), with p < 0.05 deemed significant.

Results: Among 28,953 encounters from 43 centers, median age was 154 [114-186] months, 52% were female, 45% were non-Hispanic white and median PICU LOS was 1 [1-1] days (Table). Qualitatively, the average number of admissions (Figure) varied between 2017-2019 (3172 cases/year), 2020-2021 (4366/yr) and 2022-2024 (3569/yr). Age and race varied significantly by admission year (p < 0.001). Percentage of encounters with pre-existing complex chronic conditions (overall 56.4% of cases; β = 0.02, p < 0.001) increased over time whereas percentage of encounters with mannitol administration decreased over time (2.5% of cases; β = -0.002, p = 0.001). Percentage of encounters with male gender, mortality, mechanical ventilation use, and anti-seizure medication use did not change over time.

Conclusion(s): In an administrative database from 43 children's hospitals, we observed that the number of PICU encounters with DKA or HHS has qualitatively increased since the pre-COVID era. Demographics have significantly changed including an increase in pre-existing comorbidities, but clinical outcomes have remained stable with no changes in mortality and mechanical ventilation use. Further work is needed to understand how to minimize the incidence of DKA and HHS and improve outcomes.

Demographic Characteristics and Diagnoses of Encounters Included in our Study
Table. A total of 28,953 encounters were analyzed in this study. *Age and race varied significantly by admission year (p < 0.001).

Increasing Admissions for DKA/HHS Over Time
Figure. A qualitative increase in admissions was observed during and after the COVID-19 pandemic, compared to the pre-COVID era.