Moderate and severe diabetic ketoacidosis at type 1 diabetes onset in children over two decades: A population‐based study of prevalence and long‐term glycemic outcomes. Issue 4 (17th March 2022)

• Record Type: Journal Article
• Authors: Clapin, Helen; Smith, Grant; Vijayanand, Sathyakala; Jones, Timothy; Davis, Elizabeth; Haynes, Aveni
• Is Part Of: Pediatric diabetes. Volume 23:Issue 4(2022)
• Page Start: 473
• Page End: 479
• Publication Date: 2022-03-17
• Subjects: diabetes -- DKA -- HbA1c -- pediatric -- population‐based; Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.13327
• Languages: English
• ISSNs: 1399-543X

Abstract

Abstract: Objective: To investigate in a population‐based pediatric cohort: prevalence of moderate–severe diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis over two decades and its association with long‐term glycemic control. Research Design and Methods: Children <16 years diagnosed with T1D in Western Australia 2000–2019 were included and followed up for ≤14 years. Moderate–severe DKA at diagnosis was defined as serum pH < 7.2 or bicarbonate<10 mmol/L with hyperglycemia and ketosis. HbA1c was measured ~3‐monthly. Trend in prevalence of moderate–severe DKA at diagnosis was investigated using a logistic regression model adjusting for sex, age, socioeconomic status, and area of residence. Long‐term glycemic control associated with DKA at diagnosis was investigated using linear mixed models adjusting for the same variables and also for visit frequency, CGM and pump use. Results: Moderate–severe DKA occurred in 534 of 2111 (25.3%) participants. Odds of presenting with moderate–severe DKA increased by 4.1% (95% CI: 2.3, 5.9; p < 0.001) per year. Patients with moderate–severe DKA at diagnosis had higher HbA1c levels than other patients initially; the groups were similar between 2 and 6 years duration; from 7 years HbA1c levels tracked higher in the group with moderate–severe DKA at diagnosis with significant differences at 8 and 12 years ( p < 0.05). Conclusion: The increasing prevalence of DKA at diagnosis of pediatric T1D is concerning and highlights the need for early detection programs. Unlike a similar US study, this study did not find a consistent, clinically significant relationship between DKA at diagnosis and long‐term HbA1c, raising important questions about the influence of other factors on long‐term glycemic outcomes.