Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany.
OBJECTIVE
Diabetic ketoacidosis (DKA) in children and adolescents with established type 1 diabetes is a major problem with considerable morbidity, mortality, and associated costs to patients, families, and health care systems. We analyzed data from three multinational type 1 diabetes registries/audits with similarly advanced, yet differing, health care systems with an aim to identify factors associated with DKA admissions.


METHODS
Data from 49,859 individuals <18 years with type 1 diabetes duration ≥1 year from the Prospective Diabetes Follow-up Registry (DPV) initiative (n = 22,397, Austria and Germany), the National Paediatric Diabetes Audit (NPDA; n = 16,314, England and Wales), and the T1D Exchange (T1DX; n = 11,148, U.S.) were included. DKA was defined as ≥1 hospitalization for hyperglycemia with a pH <7.3 during the prior year. Data were analyzed using multivariable logistic regression models.


RESULTS
The frequency of DKA was 5.0% in DPV, 6.4% in NPDA, and 7.1% in T1DX, with differences persisting after demographic adjustment (P < 0.0001). In multivariable analyses, higher odds of DKA were found in females (odds ratio [OR] 1.23, 99% CI 1.10-1.37), ethnic minorities (OR 1.27, 99% CI 1.11-1.44), and HbA1c ≥7.5% (≥58 mmol/mol) (OR 2.54, 99% CI 2.09-3.09 for HbA1c from 7.5 to <9% [58 to <75 mmol/mol] and OR 8.74, 99% CI 7.18-10.63 for HbA1c ≥9.0% [≥75 mmol/mol]).


CONCLUSIONS
These multinational data demonstrate high rates of DKA in childhood type 1 diabetes across three registries/audits and five nations. Females, ethnic minorities, and HbA1c above target were all associated with an increased risk of DKA. Targeted DKA prevention programs could result in substantial health care cost reduction and reduced patient morbidity and mortality.
Barbara Davis Center for Childhood Diabetes, Aurora, CO.
David M
DM
Maahs
Department of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany.
Julia M
JM
Hermann
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
Naomi
N
Holman
Jaeb Center for Health Research, Tampa, FL t1dstats@jaeb.org.
Nicole C
NC
Foster
Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
Thomas M
TM
Kapellen
Royal London Children's Hospital, Barts Health National Health Service Trust, London, U.K.
Jeremy
J
Allgrove
University of Florida, Gainesville, FL.
Desmond A
DA
Schatz
Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
Sabine E
SE
Hofer
Leeds Children's Hospital, Leeds, U.K.
Fiona
F
Campbell
Department of Pediatrics, University Hospital of Salzburg, Paracelsus Medical University, Salzburg, Austria.
Claudia
C
Steigleder-Schweiger
Jaeb Center for Health Research, Tampa, FL.
Roy W
RW
Beck
Department of Child Health, University Hospital of Wales, Cardiff, U.K.
Justin T
JT
Warner
Department of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany.
Reinhard W
RW
Holl
D000293:Adolescent; D017668:Age of Onset; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012042:Registries; D014481:United States / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology