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. 2022 Feb 14:10:820156.
doi: 10.3389/fped.2022.820156. eCollection 2022.

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

Katrin Nagl  1 , Thomas Waldhör  2 , Sabine E Hofer  3 , Maria Fritsch  4 , Dagmar Meraner  3 , Christine Prchla  5 , Birgit Rami-Merhar  1 , Elke Fröhlich-Reiterer  4
Affiliations

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

Katrin Nagl et al. Front Pediatr. .

Abstract

Objective: We analyzed the annual prevalence of onset-DKA (diabetic ketoacidosis) from 2012 to 2020 with a sub-analysis for lockdown-periods during the COVID-19 pandemic in 2020.

Design: All newly diagnosed children with type 1 diabetes (T1D) aged <15 years are prospectively registered in the population-based Austrian Diabetes Incidence Study in Austria.

Main outcome measures: The annual DKA prevalence was analyzed using Joinpoint regression. Definition of DKA: pH <7.3, mild DKA: pH 7.3 to ≤ 7.1, severe DKA: pH <7.1. DKA prevalence during the lockdown periods in 2020 and the corresponding periods in 2015-2019 were examined using Fisher's exact test.

Results: In the years 2012-2020 the mean prevalence for onset-DKA in Austria was 43.6% [95%CI (confidence interval): 41.6, 45.7] and thus above the mean prevalence of previous decades (1989-2011) of 37,1 % (95%CI: 35.6, 38.6). A particularly high prevalence was found among children <2 years of age (72.0% DKA, 32.8% severe DKA). No significant gender difference was found. Prevalence of severe DKA at T1D-onset increased significantly since 2015 (p = 0.023). During the lockdown in 2020, 59.3% of children were diagnosed with DKA at T1D-onset, compared to 42.1% during the previous 5 years (p = 0.022). Moreover, 20% of children had severe DKA at T1D diagnosis, compared to 14% during the comparison period.

Conclusions: The previously already high prevalence of DKA at T1D-onset has further increased over time. The COVID-19 pandemic has exacerbated the problem of a late or delayed diagnosis of diabetes in children resulting in onset-DKA. The alarmingly increased prevalence of DKA in Austrian children with T1D calls for urgent action.

Keywords: COVID-19; diabetes; general pediatrics; ketoacidosis; population-based registry.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Annual prevalence of onset-DKA (%) from 1989 to 2020, by severity with 95% confidence intervals. Long dashed, DKA; short dashed, mild DKA; solid, severe DKA.
Figure 2
Figure 2
Effect of age at diagnosis on estimated probability for DKA at T1D-onset (with upper and lower 95% confidence limit), adjusted for gender and year of diagnosis.
See this image and copyright information in PMC

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