Elsevier

The Journal of Pediatrics

Volume 162, Issue 2, February 2013, Pages 330-334.e1
The Journal of Pediatrics

Original Article
Diabetic Ketoacidosis at Diabetes Onset: Still an All Too Common Threat in Youth

https://doi.org/10.1016/j.jpeds.2012.06.058Get rights and content

Objective

To define the demographic and clinical characteristics of children at the onset of type 1 diabetes (T1D), with particular attention to the frequency of diabetic ketoacidosis (DKA).

Study design

The Pediatric Diabetes Consortium enrolled children with new-onset T1D into a common database. For this report, eligible subjects were aged <19 years, had a pH or HCO3 value recorded at diagnosis, and were positive for at least one diabetes-associated autoantibody. Of the 1054 children enrolled, 805 met the inclusion criteria. A pH of <7.3 and/or HCO3 value of <15 mEq/L defined DKA. Data collected included height, weight, hemoglobin A1c, and demographic information (eg, race/ethnicity, health insurance status, parental education, family income).

Results

The 805 children had a mean age of 9.2 years, 50% were female; 63% were non-Hispanic Caucasian. Overall, 34% of the children presented in DKA, half with moderate or severe DKA (pH <7.2). The risk for DKA was estimated as 54% in children aged <3 years and 33% in those aged ≥3 years (P = .006). In multivariate analysis, younger age (P = .002), lack of private health insurance (P < .001), African-American race (P = .01), and no family history of T1D (P = .001) were independently predictive of DKA. The mean initial hemoglobin A1c was higher in the children with DKA compared with those without DKA (12.5% ± 1.9% vs 11.1% ± 2.4%; P < .001).

Conclusion

The incidence of DKA in children at the onset of T1D remains high, with approximately one-third presenting with DKA and one-sixth with moderate or severe DKA. Increased awareness of T1D in the medical and lay communities is needed to decrease the incidence of this life-threatening complication.

Section snippets

Methods

The PDC cohort was enrolled at 7 US pediatric diabetes centers between July 2009 and April 2011. The protocol was approved by the Institutional Review Board of each participating center. Written informed consent was obtained from participants aged ≥18 years and from parents of children aged <18 years. Written assent also was obtained from younger youth in accordance with local Human Subjects Investigational Review Board guidelines. Inclusion criteria for this analysis required age <19 years at

Results

The 805 children included in our analysis ranged in age at the time of diagnosis from 7.9 months to 18.1 years and had a mean age of 9.2 years. The study cohort was 50% female, 63% non-Hispanic Caucasian, 22% Hispanic, and 8% non-Hispanic black, and 7% had a parent or sibling with T1D. Family income and parental education were relatively high in the participants who provided this information, and the majority had some form of health insurance.

Overall, 34% of participants presented in DKA

Discussion

In this study, DKA was present at diagnosis of T1D in more than one-third of the children. Approximately one-half of those with DKA (roughly one-sixth of the entire cohort) had moderate or severe DKA, with pH <7.2. These findings are similar to those of the SEARCH study, which reported a DKA rate of 29.4% between 2002 and 2004.11 Like the PDC, the 6 clinical centers in the SEARCH study were widely geographically distributed and provided care to ethnically diverse clinic populations in the US.

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    The Pediatric Diabetes Consortium and its activities are supported by the Jaeb Center for Health Research Foundation through an unrestrictive grant from Novo Nordisk. The University of Michigan Consortium center is supported by the Michigan Diabetes Research and Training Center from the National Institute of Diabetes and Digestive and Kidney Diseases (DK020572). Novo Nordisk and NIDDKD were not involved in: (1) the study design; (2) collection, analysis, and interpretation of data; (3) writing of the report; or (4) decision to submit the manuscript for publication. The authors declare no conflicts of interest.

    A list of members of the Pediatric Diabetes Consortium is available at www.jpeds.com (Appendix).

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