A growing number of American children and teens with type 1 diabetes are experiencing a life-threatening complication at the time of their diagnosis, a new study finds.
Researchers say a lack of insurance may mean some children are getting diagnosed with type 1 late in its development, when serious complications can arise.
The complication is called diabetic ketoacidosis (DKA), which involves dangerously high blood sugar and substances in the blood called ketones. Patients with the condition can suffer long-term health damage.
"DKA is characterized by hyperglycaemia [elevated blood sugar levels] and ketonaemia [elevated acid ketones], that, when not buffered by the body, will turn the blood acidic," explained one expert, Dr. Patricia Vuguin, a paediatric endocrinologist at Cohen Children's Medical Centre in New Hyde Park, New York.
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"Usual symptoms are vomiting, excessive thirst and urine production, as well as abdominal pain that may be severe," added Vuguin, who was not involved in the new study. "Severe DKA may lead to swelling of the brain tissue also known as cerebral oedema, which may cause headache, coma, and can lead to death."
In the new study, a team led by Dr. Arleta Rewers, from the University of Colorado School of Medicine in Aurora, looked at the medical records of more than 3,400 patients younger than 18 in Colorado who were diagnosed with type 1 diabetes between 1998 and 2012.
They found that 39 percent of the children had diabetic ketoacidosis at the time of their diagnosis.
55 percent increase in the rate of DKA patients
What's more, there was a 55 percent increase in the rate of patients with the complication at the time of diagnosis during the study period – from 30 percent in 1998 to 46 percent in 2012, the study found.
The only patient characteristic that changed over the study period was insurance, with those covered by public insurance rising from about 17 percent in 2007 to nearly 38 percent in 2012. The researchers also found that younger and black patients were more likely to have diabetic ketoacidosis, while having private insurance and a history of a close relative with type 1 diabetes was associated with a lower risk.
The findings suggest that a growing number of American youngsters with type 1 diabetes may be faced with delays in diagnosis and treatment, Rewers' team said.
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In fact, the current rate of DKA found in the study is similar to rates in countries with poor access to health care, and much higher than rates in Canada or the United Kingdom, the researchers said.
"Increasing incidence of DKA correlated temporally with an increase in Colorado child poverty prevalence from 10 percent in 2000 to 18 percent in 2012," Rewers' group wrote.
They added that "the recent increase of DKA incidence among youth with private insurance may be related to proliferation of high-deductible health plans."
Economic factors play a significant role
Vuguin agreed that "the data provided by the study suggests that economic factors such as poverty and high-deductible health plans may play a significant role in DKA [present at diagnosis]."
Another diabetes expert also pointed to the potential role of insurance.
"The authors are correctly concerned with the increased level of poverty in Colorado," said Dr. Robert Rapaport, director of paediatric endocrinology and diabetes at the Kravis Children's Hospital at Mount Sinai in New York City.
Read: Diagnosing diabetes
When children have DKA at diagnosis, this also "frequently represents failure of adequate awareness of the symptoms of diabetes and/or access to care before the children become significantly ill," he said.
The study was published April 21 in the Journal of the American Medical Association.
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