Using population data to understand the epidemiology and risk factors for diabetic ketoacidosis in Australian children with type 1 diabetes

Abstract

Background Children with type 1 diabetes (T1D) are at risk of diabetic ketoacidosis (DKA) at T1D diagnosis and/or subsequently. Objective The objective is to determine the incidence and prevalence of T1D by the presence of DKA and identify the characteristics of subsequent DKA episodes. Subjects The study population included all children aged <15 years with T1D during a hospital/day‐stay admission in New South Wales, Australia, from 1 January 2001 to 31 December 2013. T1D and DKA were identified using International Classification of Diseases Australian Modification codes. Methods Data sources included routinely collected longitudinally linked population hospitalization and birth records. Chi‐squared analyses, logistic, and multinomial regression were used to determine the association between child characteristics and admissions with and without DKA. Results The point prevalence of T1D among 0‐14‐year olds on 31 December 2013 was 144.2 per 100 000. For children aged 0‐12 years, the incidence of T1D was 16.3 per 100 000 child‐years. One‐third had DKA at T1D diagnosis and were more likely to be readmitted with DKA than those without DKA at T1D diagnosis. Children with more than one readmission for DKA were more likely to be female, reside in an inner regional area or an area of socioeconomic disadvantage, and be Australian‐born. Among all hospitalizations of children with T1D, those with DKA were more likely to be aged 10‐14 years, require intensive care, have longer length of stay, and admitted outside school days. Conclusion Routinely collected administrative health data are a reliable source to monitor incidence and health service use of childhood T1D. Children at risk of repeated DKA, particularly females, adolescents, and those from inner regional or socioeconomically disadvantaged areas, should be targeted during education and follow‐up.

Type 1 diabetes diagnosed before age 15 years in Canterbury, New Zealand: A 50 year record of increasing incidence

“…Prevalence of type 1 diabetes is arguably more difficult to determine than incidence and this is reflected by relative paucity of prevalence data available. The point prevalence of type 1 diabetes in 2013 in children 0–14 years in New South Wales, Australia was 1.44 per 1000 29 . The prevalence of the Canterbury NZ population was 1.45 per 1000 in 2011 and 1.47 per 1000 in 2015, thus similar.…”

10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

“…The main limitation of the present study was the lack of key demographic data, such as access to medical services and medical insurance, and in particular socioeconomic status, as numerous studies have reported that greater socioeconomic deprivation is associated with an increased risk of DKA at T1D diagnosis (9,11,27,32,(44)(45)(46)(47)(48)(49)(50)(51). Of note, a number of studies have shown an increased risk of DKA among ethnic minorities (11,23,45,50,52), and since ethnicity and socioeconomic status are strongly intertwined (53), our homogeneous cohort consisting solely of Han Chinese patients likely mitigated some of the potential effects of socioeconomic status.…”

“…Therefore, DKA is a metabolic complication that is relatively easily avoidable, since it primarily reflects lack of awareness of T1D symptoms (4). Other risk factors for DKA at diabetes presentation include young age, minority ethnic groups, lower socioeconomic status, limited access to medical services, lack of medical insurance, and absence of first-degree relatives with T1D (4,(9)(10)(11). Note that, in contrast to what occurs at diagnosis, insulin omission (either inadvertently or deliberately) is the main cause of recurrent DKA (7).…”

Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study

“…There is a known association between both lower socioeconomic status and rural residence and an increased risk of diabetic ketoacidosis. [23][24][25][26] Factors such as the delivery of health care services or other social services may mitigate the occurrence of adverse events, especially for those of low socioeconomic status and those living in rural areas in Newfoundland and Labrador. Furthermore, in Newfoundland and Labrador, there is less specialized adult type 1 diabetes care; however, primary care may be more consistent, which would also mitigate the occurrence of adverse events.…”