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Open Access 01-08-2020 | Ketoacidosis | Article

Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents

Authors: Valentino Cherubini, Julia M. Grimsmann, Karin Åkesson, Niels H. Birkebæk, Ondrej Cinek, Klemen Dovč, Rosaria Gesuita, John W. Gregory, Ragnar Hanas, Sabine E. Hofer, Reinhard W. Holl, Craig Jefferies, Geir Joner, Bruce R. King, Elizabeth J. Mayer-Davis, Alexia S. Peña, Birgit Rami-Merhar, Ulrike Schierloh, Torild Skrivarhaug, Zdenek Sumnik, Jannet Svensson, Justin T. Warner, Nataša Bratina, Dana Dabelea

Published in: Diabetologia | Issue 8/2020

Abstract

Aims/hypothesis

The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents.

Methods

An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status.

Results

During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5–11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia.

Conclusions/interpretation

DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.

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Title: Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents
Authors: Valentino Cherubini
Julia M. Grimsmann
Karin Åkesson
Niels H. Birkebæk
Ondrej Cinek
Klemen Dovč
Rosaria Gesuita
John W. Gregory
Ragnar Hanas
Sabine E. Hofer
Reinhard W. Holl
Craig Jefferies
Geir Joner
Bruce R. King
Elizabeth J. Mayer-Davis
Alexia S. Peña
Birgit Rami-Merhar
Ulrike Schierloh
Torild Skrivarhaug
Zdenek Sumnik
Jannet Svensson
Justin T. Warner
Nataša Bratina
Dana Dabelea
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Ketoacidosis
Type 1 Diabetes
Published in: Diabetologia / Issue 8/2020
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-020-05152-1

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