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Diabetic ketoacidosis rates increased among children diagnosed with type 1 diabetes
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Between 1998 and 2012, the incidence of diabetic ketoacidosis at the time of a type 1 diabetes diagnosis increased by 55% among youths in Colorado, according to recent study findings.
Arleta Rewers, MD, PhD, of the University of Colorado School of Medicine in Aurora, and colleagues evaluated 3,439 youths diagnosed with type 1 diabetes at any medical facility if they were a Colorado resident and followed up at the Barbara Davis Center for Diabetes in Denver between 1998 and 2012 to determine the incidence of diabetic ketoacidosis among them.
Overall, 38.9% of participants had diabetic ketoacidosis at the time of their type 1 diabetes diagnosis. Rates of diabetic ketoacidosis increased significantly after 2007 (29.9% in 1998; 35% in 2007; 46.2% in 2012; P < .001 for trend). The only characteristic that was noted to change were the number of participants who were covered by public insurance, which increased from 17.1% in 2007 to 37.5% in 2012 (P < .001).
A higher risk for diabetic ketoacidosis was found among those with a younger age (OR = 1.8; 95% CI, 1.41-2.31) and black race (OR = 1.8; 95% CI, 1.24-2.62). A lower risk was found among those with private insurance (OR = 0.37; 95% CI, 0.29-0.49) and those with a history of type 1 diabetes in a first-degree relative (OR = 0.35; 95% CI, 0.26-0.48).
Private insurance yielded an increase of diabetic ketoacidosis by 2.5% per year from 2007 to 2012, whereas public insurance yielded a decreased of 1.3% per year (P = .02 for interaction).
“Some of the factors associated with [diabetic ketoacidosis] at diagnosis are potentially modifiable,” the researchers wrote. “For example, the association with family history suggests the importance of awareness of diabetic symptoms. However, economic factors are more difficult to modify. … The recent increase of [diabetic ketoacidosis] incidence among youths with private insurance may be related to proliferation of high-deductible health plans.” – by Amber Cox
Disclosure: Rewers reports various financial ties with the Diabetes Technology Society and Roche Diagnostics International. Please see the full study for a list of all other authors’ financial disclosures.
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