Disparate Treatment of the Pediatric Diabetic Patient in the Prehospital Setting

Introduction: Current research indicates the adult population demonstrates higher tendencies in poor glycemic control based on race, ethnicity, and socioeconomic status. Assuming a similar tendency in the pediatric population, it is important to identify any disparities in prehospital treatment. 

Objective: To identify disparities in the prehospital treatment of pediatric diabetic emergencies.

Methods: A retrospective observational study of pediatric diabetic emergencies was conducted using national ESO reporting data from January 1, 2017–December 31, 2017. The database contains prehospital patient care records for over five million EMS responses from more than 900 agencies across the United States and encompasses a broad range of practice settings from urban to rural. Inclusionary criteria consisted of patients whose lowest blood glucose level (BGL) was less than 70 mg/dL, had a total Glasgow Coma Score of 14 or less, and had a primary impression that suggested a potential BGL abnormality. A multivariate logistic regression was used to calculate the odds ratio for hypoglycemic treatment (D10, D25, D50, Glucagon, and/or oral glucose) while controlling for age, weight, gender, minority status, and primary impression.

Results: A total of 251 patients met our inclusionary criteria, of whom 58.2% were Caucasian and 51.8% were male. A total of 36.7% patients received an included treatment modality, and 63.3% patients were not treated. A primary impression of altered level of consciousness was statistically significant (OR 8.05, p=0.029) regarding the treatment of prehospital pediatric hypoglycemia. Age, weight, gender, and minority status revealed no statistically significant influence on treatment.

Conclusions: The study identified no discernable disparity in the treatment of prehospital pediatric diabetic patients filtered by age in years, weight, gender, or minority status. Further study is indicated to identify the rationale for whether a patient is treated when altered mental status is identified as a primary impression.