Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: Results from SEARCH (United States) and YDR (India) registries

Abstract

Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. Methods We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. Results There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). Conclusions There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.

Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study

“…Only few studies in pediatric population report on DKA prevalence of more than 50% [18,19]. World widely, the prevalence of DKA at T1D onset widely varies by country and region and in overall is estimated to be 29.2% (95% CI: 28.82, 29.56) [20,21]. Our findings showed an upward trend in the severity of DKA.…”

“…Partially, high DKA rate can be explained by the increase in the proportion of the youngest children, who statistically more often develop DKA during T1D onset [21,22,35]. It is reported that young children present with a shorter duration of symptoms and more rapid T1D progression.…”

Diabetic ketoacidosis

“…Risk factors for DKA in children with known diabetes mellitus include poor diabetes control, previous episodes of DKA, unstable or challenging family or social circumstances, adolescent age, being a peripubertal girl and having limited access to medical services 52,53 . A study showed that, in the USA and in India, a small proportion (5.5% and 6.6%, respectively) of people aged ≤19 years who are eventually diagnosed with T2DM present with DKA 54 . Whether this is ketosis-prone T2DM is unknown, as genetic analyses on these individuals are unavailable.…”

“…Atypical antipsychotic agents have been associated with weight gain and T2DM but are also associated with DKA, which occurs acutely even in the absence of weight gain 71,72 . Cancer treatment using immune checkpoint inhibitors, such as those that block cytotoxic T lymphocyte antigen 4 (CTLA4) and PD1 or its ligand PDL1 (reFs 73,74 ), have been linked to new-onset autoimmune T1DM 54,75,76 . The WHO database of individual case safety reports described a total of 283 cases of new-onset diabetes mellitus, with >50% of patients with immune checkpoint inhibitor-induced diabetes mellitus presenting with DKA 75,76 .…”

Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative

“…Even if an episode of DKA is not immediately life‐threatening, it may lead to acute kidney injury 6 or may negatively impact cognitive development of children and adolescents 7,8 . DKA frequently occurs at the time of T1D diagnosis, 9‐11 but also during follow‐up at a rate of 1–10 events per 100 patient‐years, 4,12‐15 which does not only account for considerable morbidity and mortality, but also for substantial health care costs 16‐18 . Whereas the incidence of severe hypoglycemia in T1D has declined over the last years, the rate of DKA in established patients remains stable 10,12,13,19 .…”