title: [Frequency and influencing factors of ketoacidosis at diabetes onset in children and adolescents--a long-term study between 1995 and 2009].
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is a frequent acute complication at onset of type 1 diabetes. It is assumed that increased public awareness about diabetes symptoms may reduce DKA rate at diabetes onset. To investigate the time-dependent trend in DKA prevalence we analysed the frequency and determinants of DKA at disease onset over 15 years in pediatric patients.
  
  
  METHODS
  The prevalence of DKA at disease onset was analysed in individuals aged ≤18 years treated for the first time from 1995-2009 within 7 days after diagnosis in pediatric centers. Simple and multiple logistic regression analysis was performed to investigate influencing factors on DKA prevalence. Change of the probability of ketoacidosis over years were modelled in the logistic regression as linear trend.
  
  
  RESULTS
  16 562 individuals from 170 institutions were studied with a mean age of 9.2 ± 4.2 years. DKA (pH <7.3) was present in 20.8% of patients without a significant trend between 1995 and 2009 (p=0.222). DKA prevalence was higher in children ≤5 years (26.3%) and in the age group 10-15 years (21.7%) than in individuals aged 5-10 years (16.4%) and 15-18 years (16.9%, p<0.001). Girls had DKA more often than boys (21.2% vs. 19.3%, p=0.002). DKA frequency was increased in individuals with migration background (26.5% vs. 19.2%, p<0.001).
  
  
  CONCLUSIONS
  DKA prevalence at diabetes onset was constant at about 21% during the last 15 years. Very young children, pubertal adolescents, girls and individuals with migration background are at higher risk for DKA at diagnosis. To prevent DKA earlier diagnosis of type 1 diabetes is warranted especially in these patient groups.
authors.affiliation: Sektion Endokrinologie und Diabetologie, Universitätsklinikum Aachen, RWTH Aachen. bkarges@ukaachen.de
authors.forename: B
authors.initials: B
authors.lastname: Karges
authors.forename: A
authors.initials: A
authors.lastname: Neu
authors.forename: S E
authors.initials: SE
authors.lastname: Hofer
authors.forename: J
authors.initials: J
authors.lastname: Rosenbauer
authors.forename: W
authors.initials: W
authors.lastname: Kiess
authors.forename: H
authors.initials: H
authors.lastname: Rütschle
authors.forename: A
authors.initials: A
authors.lastname: Dost
authors.forename: H
authors.initials: H
authors.lastname: Kentrup
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000453:epidemiology*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors