1527-P: Trends in Diabetic Ketoacidosis in Kentucky, 2008-2018

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. In the U.S., DKA hospitalizations are increasing. We estimated DKA hospitalization rates in Kentucky across key subgroups. Methods: Using the statewide Kentucky Inpatient Claims Files, we examined rates of DKA hospitalization in Kentucky for adults aged ≥18 in 2008-2018. In each year, the denominator was all diabetes-related hospitalizations (any position; ICD-9 250; ICD-10 E10, E11, E13). The numerator was all DKA-related hospitalizations (any position; ICD-9 250.1; ICD-10 E10.1, E11.1, E13.1). Results: In 2008-2018, rates of DKA hospitalizations in Kentucky increased by 100% (from 2.2% in 2008 to 4.4% in 2018; Fig A). In certain subgroups, rates were markedly higher. In the subset of Medicaid-insured patients DKA rates surpassed 10% of all diabetes-related hospitalizations (Fig B). Compared to patients covered by commercial insurance or Medicare, Medicaid-insured patients show dramatic increase following Medicaid expansion (2014). In non-Hispanic (NH) blacks, rates reached 6% by 2018 (Fig C). Rates for urban and rural populations were mostly parallel but diverged slightly following Medicaid expansion (Fig D). Conclusions: Consistent with previous studies, DKA rates were higher in NH black, Medicaid-insured, and urban patients. Rates increased in all subgroups. The trends for Medicaid enrollees may show the effect of the 2014 Medicaid expansion.