Ketoacidosis at diagnosis of type 1 diabetes in children in northern Finland - Temporal changes over 20 years

OBJECTIVE - To Study the frequency of diabetic ketoacidosis (DKA) over a 20-year period among children diagnosed with type I diabetes in northern Finland. RESEARCH DESIGN AND METHODS - The study population comprised 585 patients (328 boys) diagnosed with type I diabetes aged < 15 years in the Department of Pediatrics, Oulu University Hospital, between I January 1982 and 31 December 2001. The data for clinical characteristics were collected retrospectively from the patients' case records. The earlier 10-year period (1982-1991) was compared with the later 10-year period (1992-2001). Two definitions for DKA were used: DKA(i) pH < 730 or DKA(ii) pH < 7.30 and/or bicarbonate < 15 mmolA. RESULTS - During the later 10-year period, children less often had DKA at diagnosis [DKA(i) 15.2 vs. 22.4%, P = 0.028, and DKA(ii) 18.9 vs. 29.5%, P = 0.003]. The proportion of young children aged < 5 years at diagnosis increased over time, but the frequency of DKA also was lower in this age-group during 1992-2001 compared with the earlier 10-year period [DKA(i) 17.7 vs. 32.1%, P = 0.052, and DKA(ii) 20.3 vs. 42.6%, P = 0.005]. In children aged < 2 years at diagnosis, the frequency of DKA remained high during 1992-2001 [DKA(i) 39.1% and DKA(ii) 47.8%]. CONCLUSIONS - The overall frequency of DKA in children with newly diagnosed type I diabetes decreased over a 20-year period in northern Finland. However, children aged < 2 years are still at high risk for DKA at diagnosis.