title: Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children.
abstract: OBJECTIVE
  Diabetic ketoacidosis (DKA) at diabetes diagnosis is a dangerous yet potentially preventable condition. Young age, low socioeconomic status, and low parental education have been found to be associated with increased risk of DKA. We aimed to evaluate the impact of religious affiliation on presentation with DKA at type 1 diabetes mellitus (T1DM) diagnosis in Jewish children.
  
  
  METHODS
  The study comprised an analysis of medical records of all consecutive patients with new-onset T1DM who were admitted to one tertiary medical center from January 2007 to January 2014. DKA was defined as venous pH <7.3 or HCO3(-) < 15 mmol/l, and severe DKA as pH <7.1 or HCO3(-) < 5 mmol/l.
  
  
  RESULTS
  Of 81 patients with new-onset T1DM (38 females, mean ± SD age at diagnosis 9.9 ± 4.2 years), 34 (42 %) presented with DKA: 21 of 60 (35 %) of patients from secular families and 13 of 21 (62 %) from ultra-orthodox families. Children from ultra-orthodox families had a 3.5-fold increased risk of presenting with DKA than children from secular families (95 % CI 1.2-10.1, p = 0.02) and a 3.8-fold risk to be admitted with severe DKA (95 % CI 1.1-12.6, p = 0.02). Other factors that were found to be associated with an increased risk of DKA were younger age, an absence of maternal academic education, and residence in an area of low socioeconomic status.
  
  
  CONCLUSIONS
  DKA and severe DKA at diabetes diagnosis were more common among religious ultra-orthodox than among secular Jewish children. Awareness of the symptoms and dangers of DKA in new-onset T1DM should be directed to particularly high-risk population groups.
authors.affiliation: Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel, noah.gruber@sheba.health.gov.il.
authors.forename: Noah
authors.initials: N
authors.lastname: Gruber
authors.forename: Brian
authors.initials: B
authors.lastname: Reichman
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Orit
authors.initials: O
authors.lastname: Pinhas-Hamiel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000191:economics / Q000453:epidemiology / Q000208:ethnology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007599:Judaism; D008297:Male; D012067:Religion; D012307:Risk Factors; D012923:Social Class