Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Abstract

Objective: To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes. Design: In total, 31 330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included. Methods: Admission rates for DKA (pH !7.3 or bicarbonate !15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis. Results: The mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51-5.14). The highest DKA rates were observed in patients with HbA1c R9.0% (15.83 (14.44-17.36)), age 15-20 years (6.21 (5.61-6.88)) and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) vs 4.34 (3.95-4.77), PZ0.002), and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) vs 4.57 (4.23-4.93), PZ0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) vs 1.28 (1.12-1.47), P!0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) vs patients without preceding hypoglycemia 0.42 (0.35-0.52), P!0.001). Differences remained significant after multivariable adjustment. Conclusions: The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.

Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: A neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry

“…SH was defined as “an event requiring assistance of another person to actively administer carbohydrates, glucagon, or other resuscitative actions.” SH‐coma was defined as a hypoglycemic event resulting in seizure or loss of consciousness. DKA was defined by arterial or venous blood pH < 7.3 and hospital treatment …”

Day-and-Night Hybrid Closed-Loop Insulin Delivery in Adolescents With Type 1 Diabetes: A Free-Living, Randomized Clinical Trial

“…Apart from hypoglycemia (8), reduced compliance with therapy is a major obstacle to achieving tight glucose control (9). Diabetic ketoacidosis is more common (10,11), omission of or delayed insulin boluses with meals or snacks is widespread (9,12), and discontinuation of insulin pump therapy is highest among adolescents (13). Sensor-augmented insulin pump therapy (14) and threshold-suspend features may alleviate the burden of hypoglycemia and improve outcomes (15,16), but acceptance and use of continuous glucose monitoring systems is notably reduced among teenagers (14,17).…”

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso

“…Another frequent cause of ketosis in adolescents is the neglect of the patient and his/her family who tend to relax the metabolic control supervision in older children [24][25][26] . In this case, this hypothesis is also ruled out.…”