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

Abstract

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:

2. Classification and Diagnosis of Diabetes

“…Patients with type 1 diabetes often present with acute symptoms of diabetes and markedly elevated blood glucose levels, and approximately one-third are diagnosed with life-threatening ketoacidosis (2). Several studies indicate that measuring islet autoantibodies in relatives of those with type 1 diabetes may identify individuals who are at risk for developing type 1 diabetes (17).…”

“…Occasionally, patients with type 2 diabetes may present with diabetic ketoacidosis (DKA). Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia and approximately one-third with DKA (2). The onset of type 1 diabetes may be more variable in adults, and they may not present with the classic symptoms seen in children.…”

Changes in the Frequency of Diabetic Ketoacidosis in Type I Diabetes Mellitus Cases at Diagnosis: A Fifteen-Year Single Center Experience

“…Ülkeler arasında T1DM insidans ve prevalans değişkenliğinin bu farklılığa yol açan etkenlerden biri olduğu düşünülmektedir. T1DM prevalansının yüksek olduğu ekvatordan uzak ülkelerde (Finlandiya, (8,12,14,17). Çalışmamızda tanı anında DKA saptanan olgular içerisinde erkek oranı görece daha yüksekti; ancak istatistiksel olarak anlamlı fark saptanmadı.…”

“…Tüm yaş gruplarında halen yüksek oranda rapor edilmekle birlikte, özellikle küçük yaş grubunun tanı ve tedavi gecikmesi nedeni ile daha yüksek oranda görülmektedir (5)(6)(7)(8). Bunun yanında, düşük sosyoekonomik durum, ailede diyabet öyküsünün olmaması ve T1DM prevalansının düşük olması (farkındalığın az olması) da DKA tablosu ile başvuru için risk faktörleri arasında gösterilmektedir (9,10).…”

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?

“…7 A recent US study showed that period prevalence estimates of DKA in individuals with type 1 diabetes over the last decade were high at around 30% but remained stable over time. 8 In March 2010, the JBDS published guidelines (subsequently revised in September 2013) on the management of DKA in adults. These guidelines were rapidly introduced by diabetes hospital teams across the UK and accepted as the national guideline for managing DKA.…”