Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study

Rewers, Arleta; Klingensmith, Georgeanna J.; Davis, Cralen; Petitti, Diana B.; Pihoker, Catherine; Rodríguez, Beatriz L.; Schwartz, I. David; Imperatore, Giuseppina; Williams, Desmond E.; Dolan, Lawrence M.; Dabelea, Dana

doi:10.1542/peds.2007-1105

Cited by 262 publications

(257 citation statements)

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“…The observed prevalence was distinctly higher than the recently published DKA rates in northern Finland [6] and southern Sweden [4,8], but similar to those reported for Germany [15], the UK [16] and the USA [7].…”

Section: Discussionsupporting

confidence: 84%

“…A shortcoming of our investigation is that the registry contained no data on socioeconomic factors such as family income or parental educational level or on ethnicity on an individual basis, which have been described as factors predisposing to the development of DKA [7,8,15,[20][21][22]. We found an interesting regional difference among Austrian provinces, with the highest risk in Tyrol and Vienna.…”

Section: Discussionmentioning

confidence: 86%

“…Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes and is present in 15-67% of children at the time of diagnosis [1][2][3][4][5][6][7]. The prevalence of onset DKA varies widely among studies, but most studies have been hospital-based and might therefore have been influenced by the selection bias of hospital referral [2,4,6].…”

Section: Introductionmentioning

confidence: 99%

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

2010

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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.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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

2010

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“…Unfortunately, 60~80% of DKA cases occur in children with T1DM, and 5~20% of these cases eventually relapse [2,3].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

et al. 2017

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Background: Diabetic ketoacidosis (DKA) is an acute complication of pediatric type 1 diabetes mellitus (T1DM). We aimed to determine the risk factors and clinical characteristics of children and adolescents with DKA. Methods: We retrospectively evaluated 59 episodes of DKA in 43 patients who were hospitalized for DKA between January 2006 and December 2015. DKA was classified as mild, moderate, or severe, according to patient history of DKA. The clinical and laboratory characteristics of these subgroups were compared. Results: The average patient age was 11.98 ± 4.40 years (range, 1.3~17.9 years). Moderate episodes were the most common, with 21 episodes (35.6%), followed by 19 severe (32.2%) and 19 mild episodes (32.2%). Significant differences were observed between the subgroups regarding their characteristics of aggravated. Severe DKA episodes were more often observed during the winter season. Recurrent DKA cases were determined in 31 episodes (52.5%) who were significantly older, had higher body mass index, and lower serum C-peptide levels than the newly diagnosed DKA group. Female patients experienced severe and moderate cases more frequently (P = 0.041), which included two deaths. Only blood glucoseCorresponding author: Min Sun Kim Department of Pediatrics, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, E-mail: children@jbnu.ac.kr Received: Feb. 20, 2017; Revised: Jun. 5, 2017; Accepted: Jul. 18, 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…4 Diabetic ketoacidosis (DKA) due to insulin deficiency can be a lifethreatening condition, and is often the presenting symptom of new-onset cases in both type 1 and type 2 diabetes. 5 It has been reported to be present in 25% to 30% of type 1 diabetes cases at onset [6][7][8][9][10] and from 4% to 29% in youth with type 2 diabetes, depending on race/ethnicity. [10][11][12][13][14] SEARCH previously reported that the prevalence of DKA at diagnosis was 25.5% in 2002-2003.…”

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confidence: 99%

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

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prevalence of DKA at diagnosis was 25.5% in 2002-2003. WHAT THIS STUDY ADDS: DKA in youth with type 1 diabetes remains a problem, with almost one-third presenting with DKA. Among youth with type 2 diabetes, DKA was less common and decreased by ∼10% per year, suggesting improved detection or earlier diagnosis. abstract OBJECTIVE: To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence. METHODS:Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level ,15 mmol/L and/or a pH ,7.25 (venous) or ,7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002-2003, 2004-2005, and 2008-2010). Logistic regression was used to determine factors associated with DKA. RESULTS:In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002-2003, 29.1% in 2004-2005, and 31.1% in 2008-2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P , .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002-2003 to 5.7% in 2008-2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001). CONCLUSIONS:The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time. Pediatrics 2014;133:e938-e945 AUTHORS:

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Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study

Abstract: At the time of diagnosis, 1 in 4 youth presents with diabetic ketoacidosis. Those with diabetic ketoacidosis were more likely to be hospitalized. Diabetic ketoacidosis was a presenting feature of <10% of youth with type 2. Young and poor children are disproportionately affected.

Cited by 262 publications

References 38 publications

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

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

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

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

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