Many Kids with Type 1 Diabetes Have Ketoacidosis at Diagnosis

In recent years, close to half of young patients with type 1 diabetes in Colorado have had diabetic ketoacidosis (DKA) when their diabetes was diagnosed, according to a research letter in The Journal of the American Medical Association.

The researchers analyzed 3439 patients diagnosed with type 1 diabetes before age 18 between 1998 and 2012. All were followed up at a Denver center that serves more than 80 percent of diabetic youth in Colorado. Rates, trends, and risk factors for DKA at diagnosis were assessed.

Overall, 38.9 percent of patients had DKA at the time of diabetes diagnosis. Incidence of DKA at diagnosis increased from 29.9 percent in 1998, to 35.0 percent in 2007, to 46.2 percent in 2012. The percentage of patients on public insurance increased from 17.1 percent in 2007 to 37.5 percent in 2012.

Incidence of DKA at diagnosis was higher for younger and African American patients, and lower for those with private insurance or with a first-degree relative affected by type 1 diabetes. In recent years, incidence increased to a larger extent among children with private insurance.

The study suggests rising rates of DKA at diagnosis of type 1 diabetes, consistent with diagnosis and treatment. The authors note the incidence is similar to that reported in countries with poor health care access, and much higher than in Canada or the United Kingdom. The recent trends may be related to a rising prevalence of child poverty [Rewers A, et al: Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998–2012. JAMA 2015; 313:1570–1572].