David M Maahs1, Julia M Hermann2, Naomi Holman3, Nicole C Foster4, Thomas M Kapellen5, Jeremy Allgrove6, Desmond A Schatz7, Sabine E Hofer8, Fiona Campbell9, Claudia Steigleder-Schweiger10, Roy W Beck11, Justin T Warner12, Reinhard W Holl2. 1. Barbara Davis Center for Childhood Diabetes, Aurora, CO. 2. Department of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany. 3. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 4. Jaeb Center for Health Research, Tampa, FL t1dstats@jaeb.org. 5. Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany. 6. Royal London Children's Hospital, Barts Health National Health Service Trust, London, U.K. 7. University of Florida, Gainesville, FL. 8. Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria. 9. Leeds Children's Hospital, Leeds, U.K. 10. Department of Pediatrics, University Hospital of Salzburg, Paracelsus Medical University, Salzburg, Austria. 11. Jaeb Center for Health Research, Tampa, FL. 12. Department of Child Health, University Hospital of Wales, Cardiff, U.K.
Abstract
OBJECTIVE: Diabetic ketoacidosis (DKA) in children and adolescents with established type 1 diabetes is a major problem with considerable morbidity, mortality, and associated costs to patients, families, and health care systems. We analyzed data from three multinational type 1 diabetes registries/audits with similarly advanced, yet differing, health care systems with an aim to identify factors associated with DKA admissions. RESEARCH DESIGN AND METHODS: Data from 49,859 individuals <18 years with type 1 diabetes duration ≥1 year from the Prospective Diabetes Follow-up Registry (DPV) initiative (n = 22,397, Austria and Germany), the National Paediatric Diabetes Audit (NPDA; n = 16,314, England and Wales), and the T1D Exchange (T1DX; n = 11,148, U.S.) were included. DKA was defined as ≥1 hospitalization for hyperglycemia with a pH <7.3 during the prior year. Data were analyzed using multivariable logistic regression models. RESULTS: The frequency of DKA was 5.0% in DPV, 6.4% in NPDA, and 7.1% in T1DX, with differences persisting after demographic adjustment (P < 0.0001). In multivariable analyses, higher odds of DKA were found in females (odds ratio [OR] 1.23, 99% CI 1.10-1.37), ethnic minorities (OR 1.27, 99% CI 1.11-1.44), and HbA1c ≥7.5% (≥58 mmol/mol) (OR 2.54, 99% CI 2.09-3.09 for HbA1c from 7.5 to <9% [58 to <75 mmol/mol] and OR 8.74, 99% CI 7.18-10.63 for HbA1c ≥9.0% [≥75 mmol/mol]). CONCLUSIONS: These multinational data demonstrate high rates of DKA in childhood type 1 diabetes across three registries/audits and five nations. Females, ethnic minorities, and HbA1c above target were all associated with an increased risk of DKA. Targeted DKA prevention programs could result in substantial health care cost reduction and reduced patient morbidity and mortality.
OBJECTIVE:Diabetic ketoacidosis (DKA) in children and adolescents with established type 1 diabetes is a major problem with considerable morbidity, mortality, and associated costs to patients, families, and health care systems. We analyzed data from three multinational type 1 diabetes registries/audits with similarly advanced, yet differing, health care systems with an aim to identify factors associated with DKA admissions. RESEARCH DESIGN AND METHODS: Data from 49,859 individuals <18 years with type 1 diabetes duration ≥1 year from the Prospective Diabetes Follow-up Registry (DPV) initiative (n = 22,397, Austria and Germany), the National Paediatric Diabetes Audit (NPDA; n = 16,314, England and Wales), and the T1D Exchange (T1DX; n = 11,148, U.S.) were included. DKA was defined as ≥1 hospitalization for hyperglycemia with a pH <7.3 during the prior year. Data were analyzed using multivariable logistic regression models. RESULTS: The frequency of DKA was 5.0% in DPV, 6.4% in NPDA, and 7.1% in T1DX, with differences persisting after demographic adjustment (P < 0.0001). In multivariable analyses, higher odds of DKA were found in females (odds ratio [OR] 1.23, 99% CI 1.10-1.37), ethnic minorities (OR 1.27, 99% CI 1.11-1.44), and HbA1c ≥7.5% (≥58 mmol/mol) (OR 2.54, 99% CI 2.09-3.09 for HbA1c from 7.5 to <9% [58 to <75 mmol/mol] and OR 8.74, 99% CI 7.18-10.63 for HbA1c ≥9.0% [≥75 mmol/mol]). CONCLUSIONS: These multinational data demonstrate high rates of DKA in childhood type 1 diabetes across three registries/audits and five nations. Females, ethnic minorities, and HbA1c above target were all associated with an increased risk of DKA. Targeted DKA prevention programs could result in substantial health care cost reduction and reduced patient morbidity and mortality.
Authors: Christopher M Horvat; Heba M Ismail; Alicia K Au; Luigi Garibaldi; Nalyn Siripong; Sajel Kantawala; Rajesh K Aneja; Diane S Hupp; Patrick M Kochanek; Robert Sb Clark Journal: Pediatr Diabetes Date: 2018-04-26 Impact factor: 4.866
Authors: Beate Karges; Anke Schwandt; Bettina Heidtmann; Olga Kordonouri; Elisabeth Binder; Ulrike Schierloh; Claudia Boettcher; Thomas Kapellen; Joachim Rosenbauer; Reinhard W Holl Journal: JAMA Date: 2017-10-10 Impact factor: 56.272
Authors: Daniel P Howsmon; Nihat Baysal; Bruce A Buckingham; Gregory P Forlenza; Trang T Ly; David M Maahs; Tatiana Marcal; Lindsey Towers; Eric Mauritzen; Sunil Deshpande; Lauren M Huyett; Jordan E Pinsker; Ravi Gondhalekar; Francis J Doyle; Eyal Dassau; Juergen Hahn; B Wayne Bequette Journal: J Diabetes Sci Technol Date: 2018-02-01
Authors: Jennifer L Sherr; Julia M Hermann; Fiona Campbell; Nicole C Foster; Sabine E Hofer; Jeremy Allgrove; David M Maahs; Thomas M Kapellen; Naomi Holman; William V Tamborlane; Reinhard W Holl; Roy W Beck; Justin T Warner Journal: Diabetologia Date: 2015-11-07 Impact factor: 10.122