title: Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry.
abstract: OBJECTIVE
  Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort.
  
  
  METHODS
  The analysis included 13 487 participants in the T1D Exchange clinic registry aged 2 to <26 yr with T1D ≥2 yr. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12 months.
  
  
  RESULTS
  Non-White race, no private health insurance, and lower household income were associated with higher frequencies of both SH and DKA (p < 0.001). SH frequency was highest in children <6 yr old (p = 0.005), but across the age range, SH was not associated with hemoglobin A1c (HbA1c) levels after controlling for other factors (p = 0.72). DKA frequency was highest in adolescents (p < 0.001) and associated with higher HbA1c (p < 0.001).
  
  
  CONCLUSIONS
  Our data show that poor glycemic control increases the risk of DKA but does not protect against SH in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.
authors.affiliation: Department of Endocrinology, Yale University, New Haven, CT, USA.
authors.forename: Eda
authors.initials: E
authors.lastname: Cengiz
authors.forename: Dongyuan
authors.initials: D
authors.lastname: Xing
authors.forename: Jenise C
authors.initials: JC
authors.lastname: Wong
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Wolfsdorf
authors.forename: Morey W
authors.initials: MW
authors.lastname: Haymond
authors.forename: Arleta
authors.initials: A
authors.lastname: Rewers
authors.forename: Satya
authors.initials: S
authors.lastname: Shanmugham
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.forename: Steven M
authors.initials: SM
authors.lastname: Willi
authors.forename: Diane L
authors.initials: DL
authors.lastname: Seiple
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000328:Adult; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016015:Logistic Models; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: childhood type 1; diabetic ketoacidosis; hypoglycemia; pediatric diabetes; type 1