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Risk Factors for Hyperosmolar Hyperglycemic State in Pediatric Type 2 Diabetes

Estelle M Everett1,2,3, Timothy Copeland4, Lauren E Wisk2,4

  • 1Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Pediatric Diabetes
|August 24, 2023
PubMed

Insights

Hyperosmolar hyperglycemic state (HHS) is less common than diabetic ketoacidosis (DKA) in pediatric type 2 diabetes, but associated with higher severity and mortality. Male gender and Black race are risk factors for HHS.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Mellitus

Background:

  • Limited data exists on risk factors differentiating hyperosmolar hyperglycemic state (HHS) from diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D).
  • Understanding these differences is crucial for managing hyperglycemic emergencies in youth with T2D.

Purpose of the Study:

  • To identify and compare risk factors associated with HHS versus DKA admissions in pediatric patients with T2D.
  • To analyze the severity and mortality differences between HHS and DKA in this population.

Main Methods:

  • Utilized the national Kids' Inpatient Database (2006-2019) to identify pediatric T2D admissions for DKA and HHS.
  • Employed descriptive statistics, Chi-squared tests, and logistic regression to evaluate associated factors and outcomes.
  • Excluded patients younger than 9 years old.

Main Results:

  • Of 8,961 admissions for hyperglycemic emergencies in pediatric T2D, 6% were HHS and 94% were DKA.
  • HHS admissions were more common in males (OR 1.77) and Black youth (OR 1.81) compared to DKA.
  • HHS admissions showed significantly higher odds of severe illness (11.3-fold) and mortality (5.0-fold).

Conclusions:

  • While DKA is more frequent, HHS represents a more severe hyperglycemic emergency in pediatric T2D.
  • Male gender and Black race are identified as risk factors for HHS in this demographic.
  • Further research is needed to elucidate the underlying causes of these disparities.
Abstract

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