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. 2020 Aug;63(8):1530-1541.
doi: 10.1007/s00125-020-05152-1. Epub 2020 May 8.

Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents

Valentino Cherubini  1 , Julia M Grimsmann  2   3 , Karin Åkesson  4   5 , Niels H Birkebæk  6 , Ondrej Cinek  7 , Klemen Dovč  8 , Rosaria Gesuita  9 , John W Gregory  10 , Ragnar Hanas  11   12 , Sabine E Hofer  13 , Reinhard W Holl  14   15 , Craig Jefferies  16 , Geir Joner  17   18 , Bruce R King  19 , Elizabeth J Mayer-Davis  20 , Alexia S Peña  21 , Birgit Rami-Merhar  22 , Ulrike Schierloh  23 , Torild Skrivarhaug  17   18 , Zdenek Sumnik  7 , Jannet Svensson  24 , Justin T Warner  25 , Nataša Bratina  8 , Dana Dabelea  26
Affiliations

Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents

Valentino Cherubini et al. Diabetologia. 2020 Aug.

Abstract

Aims/hypothesis: The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents.

Methods: An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status.

Results: During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5-11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia.

Conclusions/interpretation: DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.

Keywords: Children with diabetes; Complications; Diabetic ketoacidosis; Diagnosis of diabetes; Epidemiology; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
Map showing 13 centres from three continents (a) the USA, (b) Europe and (c) Australasia, participating in the DKA international collaboration project (whole nations, administrative units or clinic centres are shown). Maps by https://vemaps.com/, adapted by the authors
Fig. 2
Fig. 2
Mean DKA prevalence (per 100 people) and 95% CI at type 1 diabetes diagnosis according to year of age (all countries combined)
Fig. 3
Fig. 3
Annual DKA prevalence (per 100 people) at type 1 diabetes diagnosis and estimated annual percentage change (APC) for each country and all countries combined, during 2006–2016. Solid line, estimated prevalence trend; dashed line, 95% CI of estimated prevalence trend
See this image and copyright information in PMC

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