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Ketoacidosis higher in uninsured, low-income children with type 1 diabetes
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The incidence of diabetic ketoacidosis in children with type 1 diabetes continues to be high, although it has stabilized, according to recent findings.
In the study, researchers collected data on 7,040 children and teens with recent-onset diabetes from the registry component of the SEARCH for Diabetes in Youth Study. The SEARCH study is an ongoing, multicenter population-based study of incident diabetes in young people aged 0 to 19 years.
Of those included, 5,615 children had type 1 diabetes and 1,425 had type 2 diabetes. The investigators analyzed temporal patterns in the incidence of diabetic ketoacidosis (DKA) among pediatric patients with type 1 and type 2 diabetes during three periods of time: 2002-2003, 2004-2005 and 2008-2010. DKA was defined as a bicarbonate level less than 15 mmol/L and/or a pH level less than 7.25 (venous) or 7.3 (capillary or arterial), or documented diagnosis of DKA in medical records.
The researchers found a stable but high incidence of DKA in the patients with type 1 diabetes (30.2% in 2002-2003, 29.1% in 2004-2005 and 31.1% in 2008-2010). This prevalence was greater in children with younger age at diagnosis (P<.0001), those of minority race/ethnicity (P=.019), those who lived in lower-income households (P=.019) and those without private health insurance (P=.008). In the patients with type 2 diabetes, there was a reduction of DKA prevalence, from 11.7% in 2002-2003 to 5.7% in 2008-2010 (P=.005). In these youth, higher prevalence was related to younger age at diagnosis (P=.001), minority race/ethnicity (P=.013) and male gender (P=.001).
Dana Dabelea, MD, professor and associate dean at the University of Colorado School of Public Health, said these findings underscore the need for increased public awareness of type 1 diabetes in children, as well as improved efforts toward detection and treatment of diabetes and DKA in the uninsured and low-income patients.“Previous research suggests that increased community awareness of type 1 diabetes, including parental education and closer monitoring of signs and symptoms of diabetes, may be effective tools,” Dabelea said in a press release. “In the US, improved health care access, especially for underserved populations, is also needed to reduce the observed health disparities."
Disclosure: The researchers report no relevant financial disclosures.
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