Diabetic Ketoacidosis at Onset of Type 1 Diabetes: Rates and Risk Factors Today to 15 Years Ago

Abstract

Diabetic ketoacidosis (DKA) is a serious, potentially lethal complication of type 1 diabetes mellitus that may be present at diagnosis. The aim of this study was to determine factors associated with presentation in DKA in new-onset youth and compare the rate of DKA and risk factors to a similar study 15 years prior. This study was a retrospective chart review of newly diagnosed patients with type 1 diabetes mellitus from 2010 to 2013. Of the 276 patients, 29% presented in DKA, compared with 38% 15 years prior ( P < .002). Those with Medicaid, those misdiagnosed at initial encounter, and those not evaluated by a pediatrician initially were more likely to present in DKA ( P = .002, P = .002, P < .001, respectively). The diagnosis of diabetes was not elicited in one third of patients who ultimately presented in DKA. Pediatricians should be reeducated to ask about polyuria and polydipsia in routine encounters. Furthermore, public awareness initiatives are needed to reduce late presentation in DKA.

Prevalence and factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes: A report from a tertiary medical center in Central Pennsylvania

“…An alarming proportion of children who had a healthcare encounter within 30 days of their diagnosis of T1D but who had not been referred for concern of T1D presented in DKA (75%), which was much higher than our average rate of DKA (46%), children in the immediate referral group (37%), or those that presented to the ED directly (51%). Our findings support previous reports that a misdiagnosis of a child presenting in T1D is associated with an increased rate of DKA 7,12 . One report found rates of misdiagnosis of T1D are highest among very young children (<5) and independent of type of healthcare insurance 12 .…”

“…One report found rates of misdiagnosis of T1D are highest among very young children (<5) and independent of type of healthcare insurance 12 . Common misdiagnosis include gastroenteritis, respiratory infection, viral syndrome, yeast infection, and urinary tract infection 7 . Our data suggest children without an immediate referral during a preceding healthcare encounter are at the greatest risk of presenting in DKA and reinforces the importance of appropriate diagnostic screening for T1D in the primary care setting.…”

“…We report similar findings of no difference in the risk of DKA at diagnosis based on private insurance or Medicaid in a patient population after the implementation of the ACA in 2010; however, we still note an overall lower rate of DKA than their study. Previous reports before the implementation or the first years of the ACA found children with private insurance had lower rates of DKA compared to Medicaid 7,11,12 …”

“…A report from 2010 through 2013 compared rates of DKA at diagnosis of T1D with an earlier study in the same urban setting of Queens, New York 15 years earlier. There was a steady decrease of from 38% to 29% over this 15 year span, although it was unclear if this was due entirely to temporal differences 7 …”

“…Children diagnosed in DKA have increased morbidity, mortality, and incur higher medical costs and healthcare resource utilization including ICU level care 3 . Several previous studies have identified risk factors for children to present in DKA, including age (<5 or 10‐12), 4 Hispanic and African American race, low socioeconomic status, misdiagnosis at an initial encounter and lack of private health insurance 5‐8 . A recent study in Colorado children was the first to report similar rates of DKA among privately insured children and Medicaid aligning with the implementation of the Affordable Care Act (ACA) in 2010 9 .…”