title: Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels.
abstract: OBJECTIVE
  We investigated the long-term impact of diabetic ketoacidosis (DKA) at onset on metabolic regulation and residual beta cell function in a Danish population with type 1 diabetes.
  
  
  METHODS
  The study is based on data from DanDiabKids, a Danish national diabetes register for children. The register provides clinical and biochemical data on patients with type 1 diabetes diagnosed in 1996-2009 and then followed-up until 1 January 2012. Repeated-measurement models were used as statistical methods.
  
  
  RESULTS
  The study population comprised 2,964 children <18 years. The prevalence of DKA at diagnosis was 17.9%. Of the total subjects, 8.3% had mild, 7.9% had moderate and 1.7% had severe DKA. DKA (moderate and severe) was associated with increased HbA1c (%) levels (0.24; 95% CI 0.11, 0.36; p = 0.0003) and increased insulin dose-adjusted HbA1c (IDAA1c, 0.51; 95% CI 0.31, 0.70; p < 0.0001) during follow-up, after adjustment for covariates. Children without a family history of diabetes were more likely to present with DKA (19.2% vs 8.8%, p < 0.0001); however, these children had a lower HbA1c (%) level over time (-0.35; 95% CI -0.46, -0.24; p < 0.0001). Continuous subcutaneous insulin infusion (CSII) was associated with a long-term reduction in HbA1c, changing the effect of DKA, after adjustment for covariates (p < 0.0001).
  
  
  CONCLUSIONS
  DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA1c and IDAA1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population.
authors: Department of Paediatrics, Herlev Hospital, Arkaden, Turkisvej 14, DK 2730 Herlev, Denmark. sirifredheim@dadlnet.dk
authors: S
authors: S
authors: Fredheim
authors: J
authors: J
authors: Johannesen
authors: A
authors: A
authors: Johansen
authors: L
authors: L
authors: Lyngsøe
authors: H
authors: H
authors: Rida
authors: M L M
authors: ML
authors: Andersen
authors: M H
authors: MH
authors: Lauridsen
authors: B
authors: B
authors: Hertz
authors: N H
authors: NH
authors: Birkebæk
authors: B
authors: B
authors: Olsen
authors: H B
authors: HB
authors: Mortensen
authors: J
authors: J
authors: Svensson
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016903:Drug Monitoring; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
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