1. Diabetic ketoacidosis (DKA) at diagnosis remains common among pediatric patients with diabetes mellitus type 1, with an overall prevalence of 31.1% from 2008-2010.
2. Among patients diagnosed with diabetes mellitus type 2, DKA prevalence at presentation has decreased significantly to 5.7% in 2008-2010.
Evidence Rating Level: 2 (Good)
Study Rundown: Diabetic ketoacidosis (DKA) is a life-threatening condition that results from insulin deficiency and is characterized by symptoms that include vomiting, dehydration, and confusion. DKA is often the presenting constellation of symptoms for new-onset diabetes mellitus type 1 and type 2. This study evaluated the prevalence of DKA at diagnosis between 2008 and 2010. Prevalence of DKA at diagnosis of diabetes type 1 was found to be 31.1%, stable from previous years; however, prevalence of DKA at diagnosis of diabetes type 2 was found to be 5.7%, which is statistically lower than before. This trend suggests that, although the frequency of DKA in pediatric patients with diabetes type 1 remains significant, improved access to care and diagnosis of DKA in at-risk individuals may account for a reduced prevalence of DKA at type 2 diabetes onset. Although limited by availability of medical records to assess for DKA, this study is robust in its evaluation of DKA prevalence and suggests that with increased availability to healthcare, the prevalence of DKA may be further reduced.
In-Depth [prospective cohort study]: This study employed data collected by the SEARCH for Diabetes in Youth Study to evaluate the prevalence of DKA at diagnosis of diabetes type 1 and 2 between 2008 and 2010. The SEARCH study is an ongoing multicenter prospective cohort study that follows incident cases of diabetes in youth aged 0 to 19 years in Ohio, Washington, South Carolina, California, Colorado, Arizona, and New Mexico. 7040 new cases of diabetes were identified between 2008 and 2010; 5615 patients had type 1 diabetes and 1425 patients had type 2 diabetes. Among patients with type 1 diabetes, 31.1% (95% CI: 29.3% – 32.9%) presented with DKA, which was not significantly different from previous years (P for trend = 0.42). In contrast, DKA at presentation in patients with type 2 diabetes was 5.7% (95% CI: 4.1%-7.24%), which was significantly lower than in previous years (P for trend = 0.005). Older patients (15-19 years) were half as likely to present with DKA than younger patients (10-14 years), and non-white patients were nearly twice as likely to present with DKA than non-Hispanic white patients.
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