title: Medical expenditures associated with diabetes acute complications in privately insured U.S. youth.
abstract: OBJECTIVE
  To estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia among privately insured insulin-treated U.S. youth with diabetes.
  
  
  METHODS
  We analyzed the insurance claims of 7,556 youth, age ≤ 19 years, with insulin-treated diabetes. 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 severe hypoglycemia were estimated as the difference between predicted medical expenditures for youth who did/did not experience either DKA or severe hypoglycemia.
  
  
  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 one or more episodes of DKA ($8,455) than among those with only one episode ($3,554). Predicted mean annual total medical expenditures were $12,850 and $8,970 for youth with and without severe hypoglycemia, respectively (an excess of $3,880 for those with severe hypoglycemia). The excess was greater among those with one or more episodes ($5,929) than among those with only one ($2,888).
  
  
  CONCLUSIONS
  Medical expenditures for potentially preventable DKA and severe hypoglycemia 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. health care expenditures.
authors.affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA. sshrestha@cdc.gov
authors.forename: Sundar S
authors.initials: SS
authors.lastname: Shrestha
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Lawrence
authors.initials: L
authors.lastname: Barker
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
mesh_terms: D000293:Adolescent; D002648:Child; D048909:Diabetes Complications / Q000191:economics*; D016883:Diabetic Ketoacidosis / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin