What question did this study set out to answer?

This study investigates the relationship between demographic variables, genetic ancestry, and socioeconomic factors on the risk of diabetic ketoacidosis (DKA) in children.

June 13, 2026

2113-P: Beyond Race and Ethnicity in Pediatric Diabetes: Genetic Ancestry and Social Determinants of Health in Diabetic Ketoacidosis

Key Points

This study investigates the relationship between demographic variables, genetic ancestry, and socioeconomic factors on the risk of diabetic ketoacidosis (DKA) in children.
Analyzed a pediatric diabetes cohort with self-identified racial backgrounds.
Derived social vulnerability indices from census data and performed comparisons using Chi-square, Wilcoxon rank-sum, and Fisher’s exact tests.
Utilized multivariable logistic regression to identify predictors of DKA.
Post-diagnosis DKA occurred in 38% of Hispanic/Latino youth and 36% of non-Hispanic Black youth, compared with 10% of non-Hispanic White youth.
Genetic ancestry and socioeconomic factors were independently associated with DKA risk.
Greater neighborhood poverty and African genetic ancestry significantly increased the odds of DKA.

Abstract

Introduction and Objective: Diabetic ketoacidosis (DKA) is a major cause of morbidity in pediatric diabetes, with marked variation by race and ethnicity. However, race and ethnicity may not fully capture the biological and social determinants of health (SDoH) driving DKA risk. We studied whether post-diagnosis DKA reflects SDOH, genetic ancestry or both in diverse youth. Methods: We conducted a secondary analysis of a pediatric diabetes cohort (3-10 years’ duration; self-identified non-Hispanic Black NHB 28%, Hispanic/Latino HS 38% and non-Hispanic White NHW 25%). Social vulnerability indices were derived from American Community Survey data. Those with and without post-diagnosis DKA were compared with Chi-square, Wilcoxon rank-sum, or Fisher exact tests, and multivariable logistic regression identified DKA predictors. Results: Post-diagnosis DKA occurred in 38% of HS youth and 36% of NHB youth, compared with 10% of NHW youth. In multivariable logistic regression, genetic ancestry and SDoH were independently associated with DKA. African genetic ancestry and greater neighborhood poverty were significantly associated with increased odds of DKA (Table). Conclusion: Pediatric DKA risk reflects the joint influence of genetic ancestry and socioeconomic factors, supporting approaches that move beyond race/ethnicity to directly assess biological and social contributors to diabetic complications. Disclosure K. Jones: None. J.M. Hall: None. X. Huang: None. C.G. Minard: None. S. Dei-Tutu: None. A. Butler: None. K. Harrall: None. M. Tosur: None. M.L. Ferm: Advisory Panel; Ended; Rezolute Inc. A. Siller: None. R.S. Aguirre: Advisory Panel; Ended; Sanofi. Research Support; Current; Sanofi. M.J. Redondo: Advisory Panel; Current; Sanofi. Other - Data Safety Monitoring committee; Current; Lilly. Funding NIH NIDDK (R01 DK124395)

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