title: Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes.
abstract: OBJECTIVE
  To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes.
  
  
  METHODS
  In total, 31,330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included.
  
  
  METHODS
  Admission rates for DKA (pH < 7.3 or bicarbonate <15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis.
  
  
  RESULTS
  The mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51-5.14). The highest DKA rates were observed in patients with HbA1c ≥ 9.0% (15.83 (14.44-17.36)), age 15-20 years (6.21 (5.61-6.88)) and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) vs 4.34 (3.95-4.77), P = 0.002), and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) vs 4.57 (4.23-4.93), P = 0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) vs 1.28 (1.12-1.47), P < 0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) vs patients without preceding hypoglycemia 0.42 (0.35-0.52), P < 0.001). Differences remained significant after multivariable adjustment.
  
  
  CONCLUSIONS
  The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlin
authors.forename: Beate
authors.initials: B
authors.lastname: Karges
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Paul-Martin
authors.initials: PM
authors.lastname: Holterhus
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Beyer
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Seithe
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Vogel
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Böckmann
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Peters
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Müther
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neu
authors.affiliation: Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult