SUN-195 - National Trends in Pediatric Diabetic Ketoacidosis Hospitalizations in the United States, 2016–2022

Background: Diabetic ketoacidosis (DKA) is a leading cause of diabetes-related morbidity in youth. The COVID-19 pandemic raised concern that disrupted care and reduced healthcare access might exacerbate pediatric DKA hospitalizations, but contemporary national trends remain incompletely described.

Objective: To evaluate national trends in pediatric DKA hospitalizations in the United States across pre-pandemic (2016), peri-pandemic (2019), and post-pandemic (2022) periods, and to characterize demographic and socioeconomic disparities in DKA burden.

Methods: This cross-sectional study used the 2016, 2019, and 2022 Kids’ Inpatient Database, a nationally representative sample of pediatric hospitalizations. Hospitalizations for children aged 1–20 years with a primary or secondary ICD-10 diagnosis of DKA were identified; Infants < 1 year were excluded due to the low risk of DKA in this population and the predominance of neonatal admissions classified under newborn ICD-10 codes. DKA rates per 10,000 pediatric admissions were calculated overall and stratified by calendar year, age group, sex, race/ethnicity, primary payer, and zip-code-level household income quartile.

Results: Among 5,482,905 total pediatric hospitalizations, 128,657 involved DKA, corresponding to an overall rate of 234.7 per 10,000 admissions (95% CI, 225.5–243.8). The majority of DKA admissions occurred in youth with type 1 diabetes (92.5%), those aged 16 years and older (44.9%), and females (52.8%). DKA rates rose from 221.1 per 10,000 admissions in 2016 to 244.5 in 2019, then modestly declined to 239.8 in 2022. Rates increased sharply with age, peaking at 319.4 per 10,000 among adolescents aged 11–15 years, compared to 54.4 among children aged 1–5 years. Males had higher DKA rates than females (257.0 vs. 209.1 per 10,000, respectively). DKA burden was disproportionately greatest among Black youth (266.1 per 10,000), patients from the lowest household income quartile (248.3 vs. 186.4 in the highest quartile), and those with self-pay or Medicaid insurance status (336.9 and 224.2, respectively, vs. 223.4 for privately insured patients). In‑hospital mortality remained very low throughout the study period, though it increased from 0.1% in 2016 and 2019 to 0.2% in 2022.

Conclusions: National pediatric DKA hospitalization rates increased through 2019 and then stabilized by 2022, with no evidence of a sustained post-pandemic surge. These data suggest that the COVID-19 pandemic did not fundamentally alter trends in pediatric DKA or entrenched health inequities. DKA remains a frequent and largely preventable complication, with a disproportionate burden among adolescents, Black youth, and children experiencing socioeconomic disadvantage. These findings highlight the need for targeted interventions to improve access to diabetes care, continuity of care, and health literacy to reduce persistent disparities.

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