Treatment Equity Among Pediatric Diabetic Patients in the Prehospital Setting

Introduction: Current research indicates the adult population demonstrates higher tendencies of 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 the prehospital treatment of this underexamined population. 

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

Method: A retrospective observational study of pediatric diabetic emergencies was conducted using national ESO reporting data from January 1, 2017–December 31, 2017. Inclusionary criteria consisted of patients whose lowest blood glucose level (BGL) was less than 70 mg/dL and had a total Glasgow coma score of 14 or less and a primary impression that may have been related to BGL abnormalities. 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% (146) were Caucasian and 51.8% (130) were male. A total of 36.7% (92) patients received an included treatment modality, and 63.3% (159) 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.

Conclusion: This study identified no discernable disparity in treatment of prehospital pediatric diabetic patients when examined by age in years, weight, gender, or minority status. Further study is indicated to identify factors affecting the likelihood for treatment in the primary impression of altered mental status in pediatric prehospital patients.