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

Abstract

Objective To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time‐lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). Research Design and Methods In a population‐based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow‐up were retrieved from the “Diabetes Prospective Follow‐up” (DPV) multi‐center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. Results Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3–4.6] per 100 patient‐years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9–19.5] vs. 2.8 [2.7–3.1] per 100 patient‐years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6–11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6–3.1]; p < 0.001). Conclusions Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow‐up after each episode.

Metabolic control during the SARS‐CoV ‐2 lockdown in a large German cohort of pediatric patients with type 1 diabetes: Results from the DPV initiative

“…Clinical variables documented at each visit and considered in this study were daily insulin dose (in units per kg body weight), use of continuous glucose monitoring (CGM) systems (rtCGM or iscCGM), use of an insulin pump, body weight standard deviation score (SDS), height SDS, and body mass index (BMI) SDS based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGs) 16 . HbA1c values were mathematically standardized to the reference range of 4.05%–6.05% (IFCC 20.8–42.6 mmol/L) of the diabetes control and complications Trial applying the multiple of the mean method in order to correct for different laboratory methods 17,18 . From CGM data, mean sensor glucose values, and time in target range (70–180 mg/dl, 3.9–10.0 mmol/L; TiR) were derived.…”

“…16 HbA1c values were mathematically standardized to the reference range of 4.05%-6.05% (IFCC 20.8-42.6 mmol/L) of the diabetes control and complications Trial applying the multiple of the mean method in order to correct for different laboratory methods. 17,18 From CGM data, mean sensor glucose values, and time in target range (70-180 mg/dl, 3.9-10.0 mmol/L; TiR) were derived. The percentage of TiR shows a stable correlation with HbA1c values, as reported in a detailed meta-analysis of 18 studies providing paired TiR-HbA1c data.…”

Three‐variate trajectories of metabolic control, body mass index, and insulin dose: Heterogeneous response to initiation of pump therapy in youth with type 1 diabetes

“…In previous analyses from the DPV registry including youth with T1D on both CSII and MDI, migratory background has been associated with less beneficial longitudinal trajectories for glycemic control, 12 unfavorable diabetes outcomes, 36 and higher risk of DKA events 37 . In our analysis, however, migratory background was evenly distributed across all identified groups indicating that in our cohort, migratory background per se might have no impact, positive or negative, on trajectories of changes in HbA1c, BMI‐SDS, and insulin dose following pump start.…”

Alarming Increase of Ketoacidosis Prevalence at Type 1 Diabetes-Onset in Austria—Results From a Nationwide Registry

“…Regarding the possible lethality of diabetic ketoacidosis ( 3 ), the further course of the diabetes disease ( 33 , 34 ), and the fact that diabetic ketoacidosis can cause permanent neurological damage ( 4 , 5 ), it is important to react to the critical trend of recent years and initiate measures.…”