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Diabetic ketoacidosis risk lower in children with ongoing provider relationship
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Canadian children and adolescents with newly diagnosed type 1 diabetes treated by a usual care provider were less likely to have diabetic ketoacidosis compared with those without a usual care provider, study data show.
Meranda Nakhla, MD, MSc, assistant professor in the department of pediatrics at Montreal Children’s Hospital and the Research Institute of the McGill University Health Centre in Montreal, and colleagues evaluated data from the Registered Persons Database, Physician Service Claims Database and the Hospital Discharge Database on 3,704 children and adolescents in the province of Quebec with newly diagnosed type 1 diabetes (mean age at diagnosis, 10.1 years; 52.5% boys) to determine the association between having a usual provider of care and risk for diabetic ketoacidosis (DKA) at onset of diabetes. Participants were diagnosed with diabetes between 2006 and 2015.
Before the diagnosis of diabetes, 58.8% of participants had a usual provider of care and 26.9% presented with DKA at the time of diagnosis. The rate of DKA was highest among participants aged 5 to 11 years (32%), followed by those aged 1 to 4 years (28.5%) and those aged 12 to 17 years (21.8%).
The risk for DKA was lower among participants with a usual provider of care compared with those without a usual provider of care, and the association became stronger with increasing age; however, it was statistically significant only among participants aged 12 to 17 years. Compared with participants without a usual provider of care, participants receiving care from a family physician were 31% less likely (adjusted RR = 0.69; 95% CI, 0.56-0.85) and those receiving care from a pediatrician were 38% less likely (aRR = 0.62; 95% CI, 0.45-0.86) to present with DKA.
Researchers also evaluated the effect of socioeconomic status on the risk for DKA. Participants were categorized as “least deprived,” “moderately deprived” or “most deprived.” Participants in the most deprived category were 14% more likely to have DKA compared with those in the least deprived category (aRR = 1.14; 95% CI, 1.01-1.28). The risk for DKA was 17% higher in participants living in small cities compared with those living in urban areas (aRR = 1.17; 95% CI, 1.01-1.35).
“Our findings from this large, population-based study suggest that having a usual provider of care was associated with a decreased risk of DKA at diabetes onset and that this association strengthened with increasing age, reaching statistical significance for those aged 12 to 17 years,” the researchers wrote. “Our study provides further evidence for policymakers about the need to develop and strengthen initiatives that promote primary care for children. Our results highlight the need to develop targeted interventions for children under 12 years of age, including increasing public and physician awareness (through educations campaigns) about the symptoms of diabetes in this age group.”
In an accompanying editorial, Astrid Guttmann, MDCM, MSc, FRCPC, staff pediatrician at The Hospital for Sick Children and the Institute for Clinical Evaluative Services in Toronto, wrote that the findings “serve as an example of one of many important child health outcomes that are both sensitive to access to timely care and independently related to socioeconomic status.”
“Achieving equity in access and, ultimately, in health outcomes will require an explicit focus — both in the specific policies and programs that are implemented and in ongoing performance measurement,” Guttmann wrote. – by Amber Cox
Disclosures: Nakhla and Guttmann report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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