Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 12:1-8.
doi: 10.1159/000543139. Online ahead of print.

Regional Deprivation and Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children and Adolescents: International Comparison among 6 Countries

G Todd Alonso  1 , Christina Reinauer  2 , Georgina M Williams  3 , Rosaria Gesuita  4   5 , Craig Jefferies  6 , Klemen Dovc  7 , Julia M Grimsmann  8   9 , Taylor M Triolo  1 , Ambika Shetty  3 , Reinhard W Holl  8   9 , Valentino Cherubini  10
Affiliations

Regional Deprivation and Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children and Adolescents: International Comparison among 6 Countries

G Todd Alonso et al. Horm Res Paediatr. .

Abstract

Introduction: The incidence of diabetic ketoacidosis (DKA) at the time of diagnosis of type 1 diabetes in youth varies between countries and is influenced by socioeconomic factors. We investigated the relationship between regional deprivation indices and DKA at the diagnosis of type 1 diabetes in six countries.

Methods: We analyzed children 0.5-17.0 years old diagnosed with type 1 diabetes between 2019 and 2022 across six diabetes registries. Regional deprivation index within each country was standardized to compare each individual's socioeconomic status internationally. Log-binomial regression models assessed the association between the standardized deprivation index and DKA, with sex, age group, and year as covariates.

Results: Among 21,020 children (mean age 9.08 [SD 4.19] years), the DKA rate of 36.5%. Cohorts were Germany (n = 13,561, DKA 32.5%), Italy (4,659, 42.5%), Colorado, USA (1,318, 54.9%), Wales (769, 35.2%), New Zealand (407, 43.7%), and Slovenia (306, 37.6%). Deprivation was associated with the increased risk of DKA in children 0.5-<6 (OR 1.16 [95% CI: 1.10-1.23], p < 0.0001) and 6-<12 years of age (1.05 [1.05-1.11], p = 0.02). Female sex increased risk of DKA (1.06 [1.00-1.13], p = 0.04). The proportion of DKA was lower in 2019 than in 2020, 2021, and 2022 (each p < 0.0001).

Conclusion: Deprivation was significantly associated with the risk of DKA at the diagnosis of type 1 diabetes, and DKA was more common during the pandemic years 2020-2022 than in 2019. Younger children appear to be more vulnerable to deprivation than older patients. Understanding and reducing local and demographic-specific disparities are essential for effective intervention.

Keywords: Diabetic ketoacidosis; New onset; Pediatrics; Registry; Type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Statement

CR, GMW, RG, CJ, KD, JMG, TMT, AS, and RWH have no conflict of interest related to this project to disclose. GTA has received honorarium for an advisory board with Mannkind; KD has received honorarium for advisory boards for Medtronic and Novo Nordisk and speaker fees from Abbott, Eli Lilly, Novo Nordisk, Medtronic, and Pfizer.

References

    1. Ogle GD, James S, Dabelea D, Pihoker C, Svennson J, Maniam J, et al. Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition. Diabetes Research and Clinical Practice. 2022. Jan 1;183:109083. - PubMed
    1. Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia. 2012;55(11):2878–94. - PMC - PubMed
    1. Duca LM, Wang B, Rewers M, Rewers A. Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control. Diabetes Care. 2017. Sep 1;40(9):1249–55. - PubMed
    1. Duca LM, Reboussin BA, Pihoker C, Imperatore G, Saydah S, Mayer-Davis E, et al. Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: The SEARCH for diabetes in youth study. Pediatr Diabetes. 2019. Mar;20(2):172–9. - PMC - PubMed
    1. Shalitin S, Fisher S, Yackbovitch-Gavan M, de Vries L, Lazar L, Lebenthal Y, et al. Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control. Pediatric Diabetes. 2018;19(2):320–8. - PubMed

LinkOut - more resources