Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada

Abstract

To estimate the 11-year incidence trend of diabetic ketoacidosis (DKA) at and after the diagnosis of type 1 diabetes. Study designA retrospective cohort study using a population-based administrative cohort diagnosed with type 1 diabetes at <20 years of age from 2002 to 2012 in British Columbia, Canada. DKA at (1 episode per individual) and DKA after (multiple episodes per individual) the diagnosis of diabetes were defined as DKA occurring ≤14 days or >14 days, respectively, from diagnosis, identified using International Classification of Diseases, 9th and 10th editions codes. Incidence rate ratios were estimated using Poisson regression and DKA trends using Joinpoint regression analyses. ResultsThere were 1519 individuals (mean age at first-DKA, 12.6 ± 5.9 years; 50% male) with ≥1 DKA episode identified. Of 2615 incident cases of type 1 diabetes, there were 847 (32.4%; mean age, 9.9 ± 4.8 years; 52% male) episodes of DKA at the diagnosis of diabetes. Among prevalent cases of type 1 diabetes (1790 cases in 2002 increasing to 2264 in 2012), there were 1886 episodes of DKA after the diagnosis of diabetes (mean age at first DKA, 15.7 ± 5.2 years). The rates per 100 person-years of DKA at diabetes diagnosis (ranging from 24.1 in 2008 to 37.3 in 2006) and DKA after diabetes diagnosis (ranging from 4.9 in 2002 to 7.7 in 2008) remained stable. Females showed a 67% higher rate of incidence of DKA after the diagnosis of diabetes compared with their male counterparts (incidence rate ratio, 1.67; 95% CI, 1.50-1.86; P < .001), adjusted for the temporal trend by fiscal year. Younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis and older children (≥10 years) had a greater risk of DKA after the diagnosis of diabetes. ConclusionsThe risk of DKA at the time of diagnosis of diabetes was greater with younger age and the risk of DKA after the diagnosis of diabetes was higher in females and older children and youth.

Temporal patterns of hospitalizations for diabetic ketoacidosis in children and adolescents

“…We also found divergent temporal trends across age strata, with rising hospitalization rates confined to the youngest and oldest examined age groups. Our finding is corroborated by recent studies that also reported bimodal age distribution for DKA in type 1 diabetics [31,32]. Thus the incidence of type 1 diabetes mellitus, reported to peak in young children and older age groups [33], likely contributed to the increased hospitalization rate of DKA in these age groups.…”

Outcomes of Children and Adolescents Admitted with Diabetic Ketoacidosis at Kenyatta National Hospital (KNH), Kenya

“…Although mortality in children younger than 6 years was low at 0.6%, we had only 16 children within this age category with 1 death reported. A study done by Kao et al on the incidence and trends of DKA in children and adolescents with type 1 diabetes in British Columbia, Canada, reported that younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis [ 15 ]. We also did not report any mortality in the ICU which we attributed to close monitoring of patients in the ICU and with a prompt institution of appropriate interventions in the event of clinical deterioration.…”

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 .…”

“…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 . Female sex, adolescence, ethnic minority status, low socioeconomic status, an HbA1c level above the target range, and DKA at T1D manifestation are associated with an increased DKA frequency 10,13,20,21 .…”