SUN-560 - Identifying Health Disparities in Patients Newly Diagnosed with Type 2 Diabetes Presenting with Diabetes Ketoacidosis

Diabetes ketoacidosis (DKA) is a serious complication associated with poorly managed or undiagnosed diabetes. There is a rising prevalence of DKA among type 2 diabetes mellitus (T2DM) patients, representing about 34% of all DKA cases. Risk factors include family history, obesity, limited access to care and relatively lower screening rates, especially in adults aged 45-64. These patients have longer hospital stays and higher healthcare cost. We conducted a retrospective chart review of patients who were newly diagnosed with T2DM during a hospitalization for DKA between July of 2000 and June of 2025 at MetroHealth Medical Center Cleveland Ohio. The objective was to identify disparities in social determinant of health (SDOH) that may have contributed to a delayed diagnosis. Patients younger than 18 years old, pregnant female, or those with incomplete clinical data were excluded.

Results: 150 patients met criteria. 78.7% were males, 60.0% were black, and mean age was 46. Only 13 patients (12.6%) were Hispanic or Latino. Most patients (98; 65.3%) had a primary care provider. Only 58 patients (38.7%) had an A1C taken before their diagnosis, and from those 58.6% had an A1C recorded over a year before the admission. The average of this A1C was 6.25%. The average BMI of patients at the time of their diagnosis was 33.96kg/m2. Transportation needs and financial strain survey answers were recorded in most of the study group, 94.7% and 89.4% of the time. Food insecurity was documented in 83.0%. Housing instability and physical activity were the least recorded, 73.4% and 67.0%. 62.0% reported insufficient physical activity. Only 2.0% reported not being at risk of financial strain. 28.0% stated being at high-risk of food insecurity or housing instability.

Conclusion: Data collection relied on voluntary surveys, introducing potential bias due to unequal distribution and self-selection. Additionally, men in general, and particularly Black men may be underrepresented due to higher mistrust in healthcare and reluctance to report negative experiences which has been linked to delayed and avoided care. The geographic distribution of the hospital system appeared to align with where most of the study population resides, suggesting that location alone does not explain the observed disparities. Disparities may stem from financial strain and potential physician or system-level care gaps, which could limit access to appropriate diabetes screening. Further investigation is needed to identify and address barriers to timely A1C screening in primary care.

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