Medical Expenditures Associated with Diabetes Acute Complications in Privately-Insured U.S. Youth

  1. Giuseppina Imperatore, MD, PhD
  1. U.S. Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA


Objective-- To estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia (SH) among privately insured insulin-treated U.S. youth with diabetes.

Research design and methods-- We analyzed the insurance claims of 7,556 youth with insulin-treated diabetes age ≤19. The youth were continuously enrolled in fee-for-service health plans, and claims were obtained from the 2007 U.S. MarketScan Commercial Claims and Encounter database. We used regression models to estimate total medical expenditures and their subcomponents; outpatient, inpatient, and drug expenditures. The excess expenditures associated with DKA and SH were estimated as the difference between predicted medical expenditures for youth who did/did not experience either DKA or SH.

Results--- For youth with and without DKA, respectively, predicted mean annual total medical expenditures were $14,236 and $8,398 (an excess of $5,837 for those with DKA). The excess was statistically greater for those with >1 episode of DKA ($8,455) than among those with only 1 episode ($3,554). Predicted mean annual total medical expenditures were $12,850 and $8,970 for youth with and without SH, respectively (an excess of $3,880 for those with SH). The excess was greater among those with >1 episode ($5,929) than among those with only 1 ($2,888).

Conclusions--- Medical expenditures for potentially preventable DKA and SH in U.S. youth with insulin-treated diabetes are substantial. Improving the quality of care for these youth to prevent the development of these two complications could avert substantial U.S. healthcare expenditures.

  • Received July 22, 2010.
  • Accepted September 7, 2010.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc10-1406v1
    2. 33/12/2617 most recent