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Multicenter Study
. 2014 Apr;133(4):e938-45.
doi: 10.1542/peds.2013-2795. Epub 2014 Mar 31.

Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study

Dana Dabelea  1 , Arleta Rewers, Jeanette M Stafford, Debra A Standiford, Jean M Lawrence, Sharon Saydah, Giuseppina Imperatore, Ralph B D'Agostino Jr, Elizabeth J Mayer-Davis, Catherine Pihoker; SEARCH for Diabetes in Youth Study Group
Affiliations
Multicenter Study

Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study

Dana Dabelea et al. Pediatrics. 2014 Apr.

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.

Keywords: diabetes type; diabetic ketoacidosis; youth.

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Figures

FIGURE 1
FIGURE 1
A, Prevalence of DKA at diagnosis of type 1 diabetes by gender. B, Prevalence of DKA at diagnosis of type 1 diabetes by race/ethnicity and year. AA, African-American; HISP, Hispanic; NHW, non-Hispanic white.
See this image and copyright information in PMC

References

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