Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study

Abstract

Objective The aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016. Methods The population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0–14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression. Results The rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years. Conclusion Due to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes.

Neues zur Diabetesepidemiologie

“…Datenquellen der Erhebung von Manuwald et al [6] Daten Weitere Einzelheiten finden Sie im Artikel Manuwald et al (6). In der weiteren Publikation von Manuwald et al (8) zur Entwicklung der diabetischen Ketoazidosen bei Diabetesmanifestation wird deutlich, dass der Anstieg von schweren und mittelschweren Ketoazidosen über die Zeit größer als der zu erwartende (in Bezug auf den Anstieg der Typ-1-Diabetes-Fälle) ist [8] und deshalb dringender Handlungsbedarf zur Reduktion bzw. Prävention diabetischer Ketoazidosen bei Diabetesmanifestation besteht.…”

Typ-1-Diabetes: Früherkennung und Ansätze zur Prävention

“…Bei klinischer Manifestation hatten nur 2 von 62 Kindern aus Fr1da (3,2 %) eine Ketoazidose, mussten aber nicht intensivmedizinisch betreut werden, während die Ketoazidoserate bei nicht gescreenten Kindern in Deutschland bei bis zu 35,2 % liegt [ 20 ].…”

Significant reduction of ketoacidosis at diabetes onset in children and adolescents with type 1 diabetes—The Stuttgart Diabetes Awareness Campaign, Germany

“…The Poisson regression analysis indicated a statistically significant increased occurrence of DKA for younger age groups. The authors postulate that an educational prevention campaign is essential in Saxony to aid pediatricians, general physicians, as well as the general public to identify the early signs of type 1 diabetes 3 …”

“…The authors postulate that an educational prevention campaign is essential in Saxony to aid pediatricians, general physicians, as well as the general public to identify the early signs of type 1 diabetes. 3 In addition, the frequency of DKA rises with delayed diagnosis and in particular very young children run a higher risk of DKA. 4 DKA at diagnosis of type 1 diabetes occurs more commonly when a patient is misdiagnosed.…”