Pediatric DKA: Too Often a First-Time Diagnosis for Type 1 Diabetes

One third of children in this multicenter study presented with DKA at the time of their initial diabetes diagnosis.

Failure to diagnose type 1 diabetes before the onset of diabetic ketoacidosis (DKA) can incur unnecessary morbidity, mortality, and costs. Researchers evaluated the incidence and patient characteristics associated with DKA at the time of a new diagnosis of type 1 diabetes in children <19 years of age who presented to one of seven U.S. pediatric diabetes centers within 90 days of the diabetes diagnosis. Children were included in the analysis if at the time of diagnosis they tested positive for at least one diabetes-associated autoantibody and had pH or HCO3 values recorded.

Of 805 children (mean age, 9 years; age range, 8 months to 18 years), 277 (34%) presented with DKA, which was moderate to severe (pH <7.2) in 51%. In univariate analysis, risk for DKA was significantly higher in children aged <3 years than in older children (prevalence of DKA, 54% vs. 33%). Risk for DKA was significantly lower in children with private insurance than in those with other payer sources or no insurance (prevalence of DKA, 28%, vs. 47%) and in those with a family history of type 1 diabetes than in those without family history (14% vs. 36%). In multivariate analysis, independent predictors of DKA were younger age, lack of private health insurance, no family history of type 1 diabetes, and African American race.

Citation(s):
Klingensmith GJ et al. Diabetic ketoacidosis at diabetes onset: Still an all too common threat in youth. J Pediatr 2013 Feb; 162:330.