Teens With T1D Most at Risk of DKA, Multinational Study Finds

A survey of nearly 60,000 children with T1D provides a full picture of how often DKA happens.

Researchers have identified important differences in the occurrence of diabetic ketoacidosis (DKA) in children living with type 1 diabetes (T1D). Their findings were presented at the 53rd Annual Meeting of the European Society for Paedeatric Endocrinology in Dublin, Ireland.

DKA in children and adolescents with established T1D is a major problem with considerable cost to patients, families, and healthcare systems. Thus, it is important to better understand these data in an effort to improve current interventions.

The study included data from 59,191 patients living with T1D under 18 years of age in three registries: T1D Exchange in the United States (13,966) National Paediatric Diabetes Audit in England and Wales (18,963) and the DPV Initiative in Germany and Austria (26,262). DKA was defined as having at least one hospitalization for a pH<7.3 during the prior year.

Overall, researchers found that 5.3% of children had at least 1 DKA event in the past year with the following differences amongst countries: 6.2% US, 6.0% England, 4.5% Germany, 4.4% Wales, 3.3% Austria.

“Admission rates with DKA amongst children and young people with existing type 1 diabetes is unacceptably high and requires urgent action.” Said Dr. Justin Warner, Clinical Lead for the National Paediatric Diabetes Audit, “It is not entirely clear why there is variation in rates between the nations participating in this research, but we have been able to identify some factors that will help guide patient/family orientated structured education programmes with an ultimate aim to reduce risk of admission.”

The risk of DKA was highest in adolescents (14–18 years: 5.8%) compared to younger children (6–10 years: 3.4%). Researchers found that the frequency of DKA increased with longer duration of diabetes, showing 3.5% for less than two years duration, versus 5.9% for those patients living with T1D for two years or more. Additionally, DKA was more common in girls compared with boys and more prevalent in minority patients. Frequency of DKA was lower in patients on insulin pumps.

View the poster here.

This study was conducted by Justin T. Warner of the University of Wales, UK; Reinhard W. Holl and Julia Hermann of the University of Ulm, Germany; David M. Maahs of the Barbara Davis Center for Childhood Diabetes, USA; Thomas Kapellen of the University of Leipzig, Germany; Sabine E. Hofer of the University of Innsbruck, Austria; Claudia Schweiger of the University of Salzburg, Austria; Roy Beck and Stephanie Dubose of the JAEB Center for Health Research, USA; and Desmond Schatz of the University of Florida, USA.

About T1D Exchange

T1D Exchange, the first program of Unitio, was founded on the premise that finding faster, better therapies for type 1 diabetes (T1D) requires a research model as multi-faceted as the disease itself. T1D Exchange acts as a convener of the thousands of people working to improve patient outcomes already—by connecting them to one another and to the patient community at large. Drawing on decades of research and data that have come before, T1D Exchange aims to be the translational engine that enables the entire T1D ecosystem to collaborate in truly novel ways via the integration of a Clinic Network, Clinic Registry, Biobank, and the online patient/caregiver community, Glu.

About NPDA
The National Paediatric Diabetes Audit (NPDA) in England and Wales aims to improve the care provided to children with diabetes, their outcomes and experiences and that of their families. The NPDA is supported through the Healthcare Quality Improvement Partnership and conducted by the Royal College of Paediatric and Child Health.

About DPV
The German and Austrian DPV registry was established with an objective of improving the care of children with type 1 diabetes through sharing of best practices and the collection of clinical outcome data in large numbers of patients. The DPV is supported through the German BMBF competence network diabetes mellitus.

This story was originally published with the title “A Comparison of DKA in Multinational Pediatric T1D Patients.”

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