Racial Demographics in Pediatric HHS
In pediatric cases of hyperosmolar hyperglycemic non-ketotic syndrome, African-American children represent 83-100% of reported cases, with the most robust pediatric study showing 100% (7 of 7 patients) were African-American 1.
Evidence from Pediatric Studies
The strongest pediatric-specific evidence comes from a 2005 retrospective study at Children's Hospital of Philadelphia that reviewed 190 patients with type 2 diabetes over 5 years 1. Among the 7 children who developed HHS (representing 3.7% of their type 2 diabetes population):
- 100% were African-American (all 7 patients)
- Mean age was 13.3 years (range 10.1-16.9 years)
- 5 of 7 were male
- All presented with HHS as their initial diabetes diagnosis
A second pediatric study from 2016 examining 6 children with HHS found 2:
- 83% were African-American (5 of 6 patients)
- Age range 6-16 years
- 67% were female (contrary to the male predominance in the earlier study)
- 67% had BMI >97th percentile
Important Clinical Context
A 2007 study of adolescents and young adults (ages 10-30 years) with HHS found 60% were African-American, though this included older patients beyond the typical pediatric range 3.
Critical Pitfalls
The 2004 ADA guidelines note that "stopping insulin for economic reasons is a common precipitant of DKA in urban African-Americans," highlighting socioeconomic barriers that disproportionately affect this population 4. This underscores that the racial disparity reflects systemic healthcare access issues rather than purely biological factors.
The striking overrepresentation of African-American children in pediatric HHS cases (83-100%) demands heightened clinical vigilance in this population, particularly for new-onset diabetes presentations, while addressing underlying barriers to diabetes care and insulin access.