Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents

AimsTo identify risk factors for diabetic ketoacidosis at diagnosis of Type1 diabetes in children and adolescents. MethodsIn three time periods (1986-1987, 1996-1997 and 2006-2007) 75, 86 and 245 patients, respectively, aged <20years were newly diagnosed with Type1 diabetes in one tertiary care centre. In this retrospective comparative study, data of clinical characteristics, laboratory evaluation at diagnosis, as well as demographic data were retrieved from the patients' files. Comparative analyses were performed between patients presenting with or without diabetic ketoacidosis and between the three time periods. ResultsPatients presenting with diabetic ketoacidosis were younger (9.24.7 vs. 10.44.7years; P<0.02), thinner (weight standard deviation score -0.591.2 vs. -0.251.1; P=0.002) and less frequently had a first- and/or second-degree relative with Type1 diabetes compared with those without diabetic ketoacidosis at presentation (16.0 vs. 31.2%, respectively; P=0.001). Children with diabetic ketoacidosis were less likely to have had relevant testing before diagnosis than children without diabetic ketoacidosis. Children aged <2years presented more often with diabetic ketoacidosis than the older children (85 vs. 32%; P<0.001). Children of Ethiopian origin had a higher rate of diabetic ketoacidosis at diagnosis than the rest of the cohort (57.8 vs. 33%; P=0.04). ConclusionsFactors affecting the risk of developing diabetic ketoacidosis at diagnosis of Type1 diabetes may be related to the degree of awareness of symptoms of diabetes among parents and primary care physicians. Prevention programmes should aim at increasing awareness and consider the application of special measures to avoid diabetic ketoacidosis in children aged <2years and high-risk ethnic groups. What's new? Risk factors for diabetic ketoacidosis at diagnosis did not change over two decades. Children aged <2years and children of Ethiopian Jewish origin are at high risk for diabetic ketoacidosis at diagnosis. Factors associated with lower risk were Type1 diabetes in a first- and/or second-degree family member, screening tests for hyperglycaemia at the community clinic prior to admission, higher weight standard deviation score and older age at diagnosis. Recognizing the risk factors for diabetic ketoacidosis at presentation would be the basis for a targeted prevention programme aimed at increasing awareness and knowledge of the clinical symptoms.