title: 15-year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting (Auckland, New Zealand).
abstract: We assessed the incidence of diabetic ketoacidosis (DKA) in children aged <15 years with newly diagnosed type 1 diabetes mellitus (T1DM) in the Auckland Region (New Zealand) in 1999-2013, in a retrospective review of a complete regional cohort. DKA and its severity were classified according to ISPAD 2014 guidelines. Of 730 children presenting with new-onset T1DM over the 15-year time period, 195 cases had DKA of any severity (27%). There was no change in the incidence of DKA or the proportion of children with severe DKA at presentation. The incidence of DKA among children aged <2.0 years (n = 40) was 53% compared to 25% for those aged 2-14 years (n = 690; p = 0.005). In children aged 2-14 years, increasing age at diagnosis was associated with greater likelihood of DKA at presentation (p = 0.025), with the odds of DKA increasing 1.06 times with each year increase in age. Non-Europeans were more likely to present in DKA than New Zealand Europeans (OR 1.52; p = 0.048). Despite a consistent secular trend of increasing incidence of T1DM, there was no reduction in the incidence of DKA in new-onset T1DM in the Auckland Region over time. Thus, it is important to explore ways to reduce DKA risk.
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Craig
authors.initials: C
authors.lastname: Jefferies
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Cutfield
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: José G B
authors.initials: JG
authors.lastname: Derraik
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Jignal
authors.initials: J
authors.lastname: Bhagvandas
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Albert
authors.affiliation: 1] Liggins Institute, University of Auckland, Auckland, New Zealand [2] Gravida: National Centre for Growth and Development, Auckland, New Zealand.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hofman
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Gunn
authors.affiliation: 1] Liggins Institute, University of Auckland, Auckland, New Zealand [2] Gravida: National Centre for Growth and Development, Auckland, New Zealand.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Cutfield
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index