title: Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study.
abstract: OBJECTIVE
  To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence.
  
  
  METHODS
  Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002-2003, 2004-2005, and 2008-2010). Logistic regression was used to determine factors associated with DKA.
  
  
  RESULTS
  In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002-2003, 29.1% in 2004-2005, and 31.1% in 2008-2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002-2003 to 5.7% in 2008-2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001).
  
  
  CONCLUSIONS
  The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado;
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.forename: Arleta
authors.initials: A
authors.lastname: Rewers
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Stafford
authors.forename: Debra A
authors.initials: DA
authors.lastname: Standiford
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Sharon
authors.initials: S
authors.lastname: Saydah
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
authors.forename: Catherine
authors.initials: C
authors.lastname: Pihoker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D055815:Young Adult
keywords: diabetes type; diabetic ketoacidosis; youth