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Ketoacidosis rates remain troubling in juvenile type 1 diabetes



CHICAGO – The prevalence of diabetic ketoacidosis has fallen by about 10% annually over time in youth with type 2 diabetes, but the life-threatening condition continues to plague roughly one in three children with type 1 diabetes, according to Dr. Dana Dabelea.

"The frequency of diabetic ketoacidosis in youth with type 1 diabetes, while stable, remains high among U.S. children at one in three children, which indicates a persistent need for increased awareness and better parental education, but also better access to health care," Dr. Dana Dabelea said at the annual scientific sessions of the American Diabetes Association.

Patrice Wendling/IMNG Medical Media

Dr. Dana Dabelea

She reported on an analysis involving 5,618 youth, aged less than 20 years, with newly diagnosed diabetes in three time periods (2002-2003, 2004-2005, and 2008-2009) and enrolled in the SEARCH for Diabetes in Youth study, a national, multicenter study designed to learn more about diabetes among American children and young adults.

Diabetic ketoacidosis (DKA) was defined by ICD-9 code and/or bicarbonate levels less than 15 mmol/L and/or a venous pH less than 7.25. Based on provider assessment, 4,537 patients had type 1 diabetes and 1,081 had type 2.

U.S. trend data on DKA prevalence in type 1 diabetes are limited, while no data are available in youth with type 2 diabetes, said Dr. Dabelea, professor of epidemiology, Colorado School for Public Health, Aurora. In Europe, decreases in DKA prevalence at onset of type 1 diabetes have been reported in Sweden and Finland, but not in Germany and Austria.

In the current analysis, DKA prevalence among youth with type 1 diabetes remained high at 29.8%, 28.8%, and 28.2% between 2002 and 2003, 2004 and 2005, and 2008 and 2009 (P = .43), she said. The number of patients diagnosed was 434, 453, and 425, respectively.

For type 2 diabetes, DKA prevalence declined from 11.3% to 6.5%, and then 6.1% over the same time periods. The difference was statistically significant (P = .02), but the number of patients is very small at 37, 21, and 26, Dr. Dabelea reported.

"In youth with type 2 diabetes, DKA at onset is less common and seems to be decreasing over time, suggesting perhaps improved diagnosis in at-risk individuals," Dr. Dabelea said.

The number of patients was too small for stratified type 2 analyses. For type 1 diabetes, DKA prevalence did not vary significantly by age at onset, race, or gender, although children aged 0-4 years in addition to blacks and Hispanics had significantly higher rates in all three time periods, she said.

In multivariate analyses, higher DKA prevalence in type 1 diabetes was independently associated with younger age at onset (age 5-9, odds ratio 0.57; age 10-14, OR 0.75; age 15-19, OR 0.38; all P less than .0001 compared with age 0-4), minority race (OR 1.33; P = .002), and lack of private insurance (OR 1.33; P = .010). Gender, education, and income were not significantly associated with a higher DKA, Dr. Dabelea reported.

Independent correlates of DKA in type 2 diabetes were younger age at onset (age 15-19 vs. age 10-14: OR 0.48; P = .002), minority race (OR 2.45; P = .013), and male gender (OR 0.54; P = .008).

"With changes in health care access on the horizon through health care reform, we might begin to see future decreases in DKA prevalence over time, but we believe that focused efforts to help the minority and underserved populations will be needed to achieve this goal," Dr. Dabelea concluded.

SEARCH is funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Dabelea reported having no relevant financial disclosures.

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