Pediatric Diabetes and Concomitant Mental Health Disorders: An Analysis Leveraging the Vizient® Clinical Data Base

Editor's note: Hannah Murphy, Lead, Analytics & Insights also contributed to this blog post.

Welcome to the Pediatric Research at Vizient blog series. This series highlights some of our latest findings in pediatric medicine and incorporates analysis leveraging the Vizient® Clinical Data Base to support our pediatric research efforts. Access the first blog in the series here.

In this second post of our series, we provide insights from Vizient research on children with comorbid diabetes and mental health disorders admitted to the ED, findings from which were presented at the American Public Health Association Annual Meeting in October 2024.

Children with type 1 diabetes have a higher-than-average prevalence of psychiatric disorders, including anxiety, depression and mood disorders, and evidence shows a bidirectional association between poor mental health and poor glycemic control. Studies using the National Survey of Children’s Health found that approximately two in five children/adolescents with diabetes have a mental, behavioral or developmental disorder, compared to one in five in the nondiabetic population. The current study aimed to assess patient-level outcomes among children with diabetes and mental health disorders admitted to the ED by examining sociodemographics, risk factors and in-hospital outcomes between 2018 and 2023, while incorporating a vulnerability index to identify social needs and barriers to health care at the neighborhood level.

We analyzed 18,860,924 pediatric ED encounters in 2018–2023 from 621 hospitals among children aged 2 to 17 years, assessing each for the presence of a diabetes diagnosis, a mental health diagnosis, race, ethnicity, sex and Vizient Vulnerability Index™ (VVI)* category. A total of 739,353 (3.9%) encounters took place with children with diabetes.
Our findings highlight the connectivity of mental health disorders and diabetes while illustrating disparate experiences among children in lower-resourced settings. The following results pertain to the pediatric population studied.

Key Finding #1: Co-occurrence of Diabetes and Mental Health Disorders Is High

More than one in four children with diabetes, 26.7%, presented with a concomitant mental health disorder, compared to just 11.6% of those without diabetes. Those with diabetes and substance use, mood and anxiety disorders were found to have significantly higher rates of ED visits than those without diabetes.

Figure 1. Comparing Mental Health Disorder Prevalence by Diabetes Status

Key Finding #2: Underdiagnosis Is Underscored by Disparity

Children with diabetes seen in rural or smaller hospitals were less likely than those seen in urban hospitals to have a documented mental health disorder, suggesting under-recognition and limited access to behavioral health screening and care in these settings. In addition, children who were not White were less likely than children of White race to have a documented mental health–related diagnosis.

Key Finding #3: Social and Economic Vulnerabilities Amplify Risk

Children with diabetes covered by Medicaid and living in higher-vulnerability zip codes were significantly more likely than those covered by commercial insurance and living in low-vulnerability zip codes to have a mental health disorder, emphasizing the impact of social determinants on pediatric chronic disease outcomes. Similarly, males and older-aged youths were more likely than other population segments to have a mental health disorder among the diabetes sample.

Figure 2. Adjusted Odds Ratios by Demographic and Clinical Factors (click to enlarge)

Sg2’s Perspective

These findings uniquely reveal trends in utilization among children with comorbid conditions, quantifying the prevalence of comorbidity and layering on the impacts of social determinants of health. Taken together, these data-driven insights inform meaningful steps children’s health systems must take to support strategic efforts across multiple priority service areas: the emergency department, behavioral health care and chronic disease management. Key steps include the following:

• Integrate mental health care into diabetes programming. Findings clearly indicate an increased risk of mental health disorders among diabetic patients. Begin screening and treating mental health at the time of diabetes diagnosis. Ensure screening for high-risk populations, such as Medicaid patients living in high-vulnerability zip codes. Advanced models integrate mental health professionals into endocrine clinics.
• Enhance access to mental health screening, particularly in rural communities. Limited access to providers and screenings drives a known underdiagnosis of mental health disorders. Leverage partnerships and virtual models to expand the reach of mental health care providers.
• Ensure ED spaces are equipped to manage comorbid conditions. Create dedicated safe spaces for children experiencing medical and behavioral health exacerbations. Leverage this touchpoint for social needs assessment.

Click here to access the full research presentation on this topic.

*The patent pending Vizient® Vulnerability Index™ identifies social needs and obstacles to care in neighborhoods that may influence a person’s overall health. Public access is available here.
Sources: Ordooei M et al. Dis Diagn. 2022;11(2):54–57; Barrett CE et al. J Pediatr. 2023;253:25–32; Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com; Vizient Vulnerability Index. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.