Johanna Hammersen1, Sascha R Tittel2,3, Katharina Warncke4, Maria Fritsch5, Kerstin Placzek6, Danièle Pacaud7,8, Beate Karges9,10, Joachim Woelfle1, Reinhard W Holl2,3. 1. Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany. 2. Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany. 3. German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. 4. Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany. 5. Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. 6. Pediatric and Adolescent Medicine, University Hospital, Martin-Luther University, Halle, Germany. 7. Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. 8. Department of Pediatric Diabetes and Endocrinology, Alberta Children's Hospital, Calgary, Alberta, Canada. 9. Division of Endocrinology and Diabetology, Medical Faculty, RWTH Aachen University, Aachen, Germany. 10. Department of Pediatrics, Bethlehem Hospital Stolberg, Stolberg, Germany.
Abstract
OBJECTIVE: To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time-lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: In a population-based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow-up were retrieved from the "Diabetes Prospective Follow-up" (DPV) multi-center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. RESULTS: Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3-4.6] per 100 patient-years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9-19.5] vs. 2.8 [2.7-3.1] per 100 patient-years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6-11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6-3.1]; p < 0.001). CONCLUSIONS: Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow-up after each episode.
OBJECTIVE: To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time-lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: In a population-based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow-up were retrieved from the "Diabetes Prospective Follow-up" (DPV) multi-center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. RESULTS: Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3-4.6] per 100 patient-years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9-19.5] vs. 2.8 [2.7-3.1] per 100 patient-years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6-11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6-3.1]; p < 0.001). CONCLUSIONS: Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow-up after each episode.
Authors: Katrin Nagl; Thomas Waldhör; Sabine E Hofer; Maria Fritsch; Dagmar Meraner; Christine Prchla; Birgit Rami-Merhar; Elke Fröhlich-Reiterer Journal: Front Pediatr Date: 2022-02-14 Impact factor: 3.418
Authors: Martin Tauschmann; Anke Schwandt; Nicole Prinz; Marianne Becker; Torben Biester; Melanie Hess; Martin Holder; Beate Karges; Andrea Näke; Oliver Kuss; Simone von Sengbusch; Reinhard W Holl Journal: Pediatr Diabetes Date: 2022-02-04 Impact factor: 3.409