Original ArticleDiabetic Ketoacidosis at Diabetes Onset: Still an All Too Common Threat in Youth
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.
References (28)
- et al.
Is diabetic ketoacidosis at disease onset a result of missed diagnosis?
J Pediatr
(2010) - et al.
Characteristics at diagnosis of type 1 diabetes in children younger than 6 years
J Pediatr
(2006) - et al.
Causes of death in children with insulin-dependent diabetes 1990-96
Arch Dis Child
(1999) - et al.
Recent trends in hospitalization for diabetic ketoacidosis in Ontario children
Diabetes Care
(2002) - et al.
The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus
Pediatr Diabetes
(2011) Improving care of children with type 1 diabetes through collaborative research
Diabetes Technol Ther
(2010)- et al.
Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association
Diabetes Care
(2006) The Diabetes Control and Complications Trial (DCCT): design and methodologic considerations for the feasibility phase
Diabetes
(1986)- et al.
ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents
Arch Dis Child
(2004) - et al.
How well does serum bicarbonate concentration predict the venous pH in children being evaluated for diabetic ketoacidosis?
Pediatr Emerg Care
(2011)
Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study
Pediatrics
Increased incidence and severity of diabetic ketoacidosis among uninsured children with newly diagnosed type 1 diabetes mellitus
Pediatr Diabetes
Rapid weight gain in children soon after diagnosis of type 1 diabetes: is there room for concern?
Pediatr Diabetes
Cited by (81)
Diabetic ketoacidosis: A consensus statement of the Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology and Pediatric Diabetoloy (SIEDP)
2020, Nutrition, Metabolism and Cardiovascular DiseasesEvaluation and Management of the Critically Ill Adult With Diabetic Ketoacidosis
2020, Journal of Emergency MedicineThe MHC Class II Antigen-Processing and Presentation Pathway Is Dysregulated in Type 1 Diabetes
2023, Journal of ImmunologyLeukocytosis and C-Reactive Protein Levels as Indicators of Infection in Children With Diabetic Ketoacidosis
2023, Pediatric Emergency CareEarly Parameter to Detect the Resolution of Pediatric Diabetic ketoacidosis
2023, Research Square
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).