Hospitalizations for a feared complication of diabetes, diabetic ketoacidosis (DKA), rise sharply as adolescents transition to adulthood in the U.S, but not in Canada, according to a new study published May 8 in the Journal of General Internal Medicine. DKA can generally be prevented with regular use of insulin. The increased DKA rate in the U.S. occurs around age 18, a time when many adolescents change or lose insurance coverage, a disruption that places them at risk for skipping medical visits or being unable to afford insulin.
The study, conducted by an international team of researchers at the Harvard Medical School, Cambridge Health Alliance, the City University of New York at Hunter College, and the University of Manitoba in Canada, analyzed nearly 170,000 hospitalizations in the U.S. and 1,300 in Manitoba, Canada. Among teenagers, the investigators found, the DKA hospitalization rate was slightly higher in the U.S. compared to Manitoba. However, as teenagers became young adults, the hospitalization rate soared by 90% in the U.S., but only rose 23% in Canada.
"The U.S. health care system is failing far too many patients, including those with diabetes," noted lead author Dr. Adam Gaffney, an instructor at Harvard Medical School and a pulmonary and critical care physician at Cambridge Health Alliance. "In American, 29 million are uninsured, while far more face unaffordable deductibles or sky-high drug costs--including for insulin. The consequences can be deadly."
"Despite Obamacare, millions of Americans are uninsured, and the uninsurance rate is highest among young adults," noted Dr. Andrea Christopher, lead author and a primary care doctor now at the University of Washington School of Medicine. "Even with insurance, drug copayments are often so high that young people with diabetes can't afford the insulin they need to survive."
Dr. Steffie Woolhandler, study author and a distinguished professor of public health at CUNY's Hunter College and lecturer in medicine at Harvard Medical School added, "We know from other studies that thousands die each year because they're uninsured, and millions skip their medications because of costs. Meanwhile, drug companies have been hiking the price of insulin and other vital drugs in our country, charging twice as much as elsewhere. The combination of poor coverage and outrageous drug prices often lands patients in the hospital--or worse."
"The Incidence of Diabetic Ketoacidosis During 'Emerging Adulthood' in the USA and Canada: a Population-Based Study." Adam Gaffney, MD, MPH; Andrea Christopher, MD, MPH; Alan Katz, MBChB, MSc; Dan Chateau, PhD; Chelsey McDougall, MSc; David Bor, MD; David Himmelstein, MD; Steffie Woolhandler, MD, MPH; Danny McCormick, MD, MPH. Journal of General Internal Medicine, published online May 8, 2019. DOI: 10.1007/s11606-019-05006-6