Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents

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  • Valentino Cherubini, Salesi Hospital
  • ,
  • Julia M. Grimsmann, Ulm University, German Center for Diabetes Research (DZD)
  • ,
  • Karin Åkesson, Linköping University, Ryhov County Hospital
  • ,
  • Niels H. Birkebæk
  • Ondrej Cinek, Charles University
  • ,
  • Klemen Dovč, University of Ljubljana
  • ,
  • Rosaria Gesuita, Marche Polytechnic University
  • ,
  • John W. Gregory, Cardiff University
  • ,
  • Ragnar Hanas, NU Hospital Group, University of Gothenburg
  • ,
  • Sabine E. Hofer, Innsbruck Medical University
  • ,
  • Reinhard W. Holl, Ulm University, German Center for Diabetes Research (DZD)
  • ,
  • Craig Jefferies, Starship Children’s Health
  • ,
  • Geir Joner, University of Oslo
  • ,
  • Bruce R. King, University of Newcastle
  • ,
  • Elizabeth J. Mayer-Davis, University of North Carolina
  • ,
  • Alexia S. Peña, University of Adelaide
  • ,
  • Birgit Rami-Merhar, Medical University of Vienna
  • ,
  • Ulrike Schierloh, DECCP
  • ,
  • Torild Skrivarhaug, University of Oslo
  • ,
  • Zdenek Sumnik, Charles University
  • ,
  • Jannet Svensson, University of Copenhagen
  • ,
  • Justin T. Warner, Cardiff & Vale University Health Board
  • ,
  • Nataša Bratina, University of Ljubljana
  • ,
  • Dana Dabelea, University of Colorado Anschutz Medical Campus

Aims/hypothesis: The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. Methods: An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status. Results: During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5–11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia. Conclusions/interpretation: DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.

Original languageEnglish
JournalDiabetologia
Volume63
Issue8
Pages (from-to)1530-1541
ISSN0012-186X
DOIs
Publication statusPublished - Aug 2020

    Research areas

  • Children with diabetes, Complications, Diabetic ketoacidosis, Diagnosis of diabetes, Epidemiology, Type 1 diabetes

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