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DKA at type 1 diabetes diagnosis worsens glycemic control
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Children whose diagnosis of type 1 diabetes coincided with diabetic ketoacidosis have worse glycemic control than those without the condition at diagnosis, study data show.
Arleta Rewers, MD, PhD, associate professor in pediatrics-emergency medicine at the University of Colorado School of Medicine, and colleagues evaluated data from 3,364 Colorado residents who were diagnosed with type 1 diabetes before age 18 years, between 1998 and 2012, and monitored for up to 15 years. Overall, 39% of participants had diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis. Researchers sought to determine whether DKA before diagnosis of type 1 diabetes predicts poor glycemic control independent of established risk factors.
DKA was classified as mild/moderate (bicarbonate, 5-14 mEq/L) or severe (bicarbonate, < 5 mEq/L). Participants had HbA1c levels measured an average of 2.8 times per year.
HbA1c was 1.4% higher in participants with severe DKA (P < .0001) and 0.9% in those with mild/moderate DKA (P < .0001) compared with participants without DKA. The effects of DKA were independent of ethnic minority status, which predicted higher HbA1c by 0.5% (P < .0001); lack of health insurance at diagnosis, which predicted higher HbA1c by 0.2% (P < .0001); insulin pump use, which predicted lower HbA1c by 0.4% (P < .0001); and a parent or sibling with type 1 diabetes, which predicted lower HbA1c by 0.2% (P = .01).
“This study demonstrated that children diagnosed with type 1 diabetes presenting in DKA (mild/moderate or severe) was associated with higher long-term HbA1c levels during follow-up compared with the children who were not diagnosed with type 1 diabetes in DKA,” the researchers wrote. “Lower residual insulin secretion in children presenting with DKA may be at fault and could be prevented with earlier diagnosis.” – by Amber Cox
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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In a cohort of 3364 children from 1998 to 2012, Duca and colleagues found that diabetic ketoacidosis at diagnosis of type 1 diabetes predicted HbA1c values 0.3% to 1% higher during longitudinal follow-up, independent of age, sex, race/ethnicity and insurance. Because awareness campaigns and screening of high-risk populations have demonstrated reduction in DKA at diagnosis, these new data support the importance and feasibility of prospective studies to evaluate any causative link between DKA at diagnosis and future impact on glycemic control. If such a link exists, is it possible that different rates of DKA at diagnosis between countries partially explain international differences in HbA1c? Could the rising rates of DKA at diagnosis in the U.S. be offsetting any expected decrease in HbA1c due to improved technology uptake? I look forward to the results from ongoing population-based screening studies for type 1 diabetes and hope that DKA at onset may prove to be another modifiable risk factor to improve long-term outcomes.
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