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Intensive sick day interventions reduced the overall frequency of diabetic ketoacidosis admissions in children with type 1 diabetes. However, African American children on Medicaid still make up most diabetic ketoacidosis hospitalizations.

Patients with type 1 diabetes are at risk of developing a life-threatening condition known as diabetic ketoacidosis. It is a preventable complication of diabetes and typically occurs due to insulin omission or inadequate insulin administration. Diabetic ketoacidosis is the leading cause of morbidity and mortality in children with type 1 diabetes. However, ethnic minorities and those with lower socioeconomic status are disproportionally affected. Therefore, implementing intensive sick day rules may reduce hospitalizations caused by diabetic ketoacidosis in children with type 1 diabetes.

A study published in the Journal of the National Medical Association reviewed the charts of all patients with type 1 diabetes in a pediatric urban tertiary care center between 2015 and 2017. They compared episodes of diabetic ketoacidosis per 100 patients using the trends test over the study period. Pediatric patients who had diabetic ketoacidosis in 2015 were analyzed as a subgroup.

The frequency of diabetic ketoacidosis per 100 patients decreased during the study period. The results were:

2015: 19.1
2016: 15.2
2017: 12.4

Researchers found the decrease statistically significant. In addition, the longitudinally-followed participants in the 2015 subgroup also saw a decline in episodes. This decline, too, was statistically significant. However, not all patient groups experienced this downward trend. For example, African American children on Medicaid did not see a change with the implementation of intensive sick day rules.

In addition, African Americans continued to make up most of the recurrent admissions for diabetic ketoacidosis. Therefore, additional research is needed to ensure that interventions can improve health outcomes across socioeconomic and racial barriers.

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Dye, A. M., Alemzadeh, R., Wang, J., Tolley, E. A., & Lahoti, A. (2022). Intensive sick day rules to prevent recurrent diabetic ketoacidosis- An intervention that exemplifies health disparities. Journal of the National Medical Association, 114(1), 30-37. https://doi.org/10.1016/j.jnma.2021.10.001

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