Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

Abstract

Aim The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)) on a population basis in the whole of Austria. Methods A prospective population-based incidence study (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH<7.3 and severe DKA as pH<7.1. Time trends were estimated using linear regression models. Results During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p< 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p<0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/ 100,000 (p<0.0001), no significant change in the prevalence of DKA at manifestation was observed. Conclusions The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset.

Trends in the Prevalence of Ketoacidosis at Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study

“…19 Similar to our data, a systematic review of 46 studies involving .24 000 children in 31 countries worldwide identified younger age, ethnic minority, and lack of health insurance, among others, as major risk factors for DKA at onset with type 1 diabetes. 29 Younger age was consistently associated with increased risk of DKA at onset in numerous studies, and the reasons are likely multifactorial.…”

Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

“…For instance, Schober et al (26) reported that of 1,238 Austrian children with DKA, 383 (11.5%) had severe DKA. In the study of Oyarzabal et al (15) severe DKA was diagnosed in 17.8% DKA episodes.…”

Trends in the Prevalence of Ketoacidosis at Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study

“…However, no such trends were reported from Austria or Germany. [18][19][20] There is limited long-term trend information in youth with type 1 diabetes from North American populations, [21][22][23] and to our knowledge, no trend data on DKA among youth with type 2 diabetes. Thus, the goal of this analysis was to estimate temporal changes in the prevalence of DKA at diabetes onset among youth aged 0 to 19 years when diagnosed with type 1 or type 2 diabetes, overall and by age, gender, and race/ethnicity, and to explore factors associated with its occurrence over time.…”