2938-LB: Rate of Diabetes Ketoacidosis among Pediatric Population Living with Type 2 Diabetes in the United States: A Real-world Study Using Administrative Claims Data

Introduction and Objective: Diabetic ketoacidosis (DKA) is a serious complication of diabetes, with rising hospitalizations despite increasing use of continuous glucose monitoring (CGM). This study evaluated the association of Libre CGM acquisition on DKA among children living with type 2 diabetes (T2D). Methods: This is a retrospective analysis of Inovalon Insights claims from 2017 to 2024. Inclusion criteria were children age 18 years with T2D who initiated Libre and maintained continuous enrollment for12 months before and after acquisition. DKA events were identified from inpatient and emergency department claims, and rate ratios (RR) were estimated using zero-inflated negative binomial model adjusting for demographics, therapy type, comorbidities, and insurance type. Results: Among 1,575 children with T2D, DKA rates declined from 19.68 to 4.38 events per 100 person-years pre- vs. post-Libre. In the subgroup for those using multiple daily injections (MDI; n=1,083), rates reduced significantly from 27.91 to 5.72 events per 100 person-years (RR=0.166; p0.005). Conclusion: The initiation of CGM alone may not mitigate all DKA cases in pediatric population with T2D, particularly among those on MDI therapy. This study highlights the need for continuous ketone monitoring to deliver a targeted solution for DKA prevention and management. Disclosure L. Ekhlaspour: Advisory Panel; Current; Abbott Diabetes. Research Support; Current; Abbott Diabetes. Consultant; Current; Tandem Diabetes Care, Inc. Research Support; Current; Tandem Diabetes Care, Inc. Consultant; Ended; Jaeb Center for Health Research. Advisory Panel; Current; MannKind Corporation. Research Support; Current; MannKind Corporation. Advisory Panel; Current; Medtronic. Research Support; Current; Medtronic. Advisory Panel; Current; Sequel. Speaker's Bureau; Current; Tandem Diabetes Care, Inc. Other - Received honorarium for a presentation at ADA; Current; Medtronic. Advisory Panel; Current; Sanofi. Other - Received honorarium for a Sanofi-sponsored grant for garndrounds; Ended; Med Learning Group. Advisory Panel; Current; Diabetes Center Bern. Speaker's Bureau; Ended; Insulet Corporation. Other - Rceived honorarium for presenting at an education event sponsored by MannKind; Current; Children with Diabetes. Research Support; Current; Breakthrough T1D, Sanofi. Other - Presented at a Mannkind Sponsored program; Current; CGMEducation.net. Research Support; Current; Helmsley Trust. A. Lee: Employee; Current; Abbott Diabetes. E. Huang: Employee; Current; Abbott Diabetes. Funding Sponsorship: Abbott Diabetes Care