title: Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents.
abstract: OBJECTIVE
  To identify risk factors for diabetic ketoacidosis at diagnosis of Type 1 diabetes in children and adolescents.
  
  
  METHODS
  In three time periods (1986-1987, 1996-1997 and 2006-2007) 75, 86 and 245 patients, respectively, aged < 20 years were newly diagnosed with Type 1 diabetes in one tertiary care centre. In this retrospective comparative study, data of clinical characteristics, laboratory evaluation at diagnosis, as well as demographic data were retrieved from the patients' files. Comparative analyses were performed between patients presenting with or without diabetic ketoacidosis and between the three time periods.
  
  
  RESULTS
  Patients presenting with diabetic ketoacidosis were younger (9.2 ± 4.7 vs. 10.4 ± 4.7 years; P < 0.02), thinner (weight standard deviation score -0.59 ± 1.2 vs. -0.25 ± 1.1; P = 0.002) and less frequently had a first- and/or second-degree relative with Type 1 diabetes compared with those without diabetic ketoacidosis at presentation (16.0 vs. 31.2%, respectively; P = 0.001). Children with diabetic ketoacidosis were less likely to have had relevant testing before diagnosis than children without diabetic ketoacidosis. Children aged < 2 years presented more often with diabetic ketoacidosis than the older children (85 vs. 32%; P < 0.001). Children of Ethiopian origin had a higher rate of diabetic ketoacidosis at diagnosis than the rest of the cohort (57.8 vs. 33%; P = 0.04).
  
  
  CONCLUSIONS
  Factors affecting the risk of developing diabetic ketoacidosis at diagnosis of Type 1 diabetes may be related to the degree of awareness of symptoms of diabetes among parents and primary care physicians. Prevention programmes should aim at increasing awareness and consider the application of special measures to avoid diabetic ketoacidosis in children aged < 2 years and high-risk ethnic groups.
authors.affiliation: The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah-Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: de Vries
authors.forename: L
authors.initials: L
authors.lastname: Oren
authors.forename: L
authors.initials: L
authors.lastname: Lazar
authors.forename: Y
authors.initials: Y
authors.lastname: Lebenthal
authors.forename: S
authors.initials: S
authors.lastname: Shalitin
authors.forename: M
authors.initials: M
authors.lastname: Phillip
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology*; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012307:Risk Factors; D015431:Weight Loss; D055815:Young Adult