Joseph E O'Reilly1, Anita Jeyam2, Thomas M Caparrotta2, Joseph Mellor3, Andreas Hohn2, Paul M McKeigue3, Stuart J McGurnaghan2, Luke A K Blackbourn2, Rory McCrimmon4, Sarah H Wild3, John R Petrie5, John A McKnight6, Brian Kennon7, John Chalmers8, Sam Phillip9, Graham Leese10, Robert S Lindsay5, Naveed Sattar5, Fraser W Gibb11, Helen M Colhoun. 1. Institute Of Genetics And Cancer, University of Edinburgh, Edinburgh, U.K. joreill@ed.ac.uk. 2. Institute Of Genetics And Cancer, University of Edinburgh, Edinburgh, U.K. 3. Usher Institute, University of Edinburgh, Edinburgh, U.K. 4. Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K. 5. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 6. Western General Hospital, National Health Service Lothian, Edinburgh, U.K. 7. Queen Elizabeth University Hospital, Glasgow, U.K. 8. Diabetes Centre, Victoria Hospital, Kirkcaldy, U.K. 9. Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, U.K. 10. Ninewells Hospital, National Health Service Tayside, Dundee, U.K. 11. Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, U.K.
Abstract
OBJECTIVE: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics. RESEARCH DESIGN AND METHODS: All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation. RESULTS: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates. CONCLUSIONS: DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
OBJECTIVE: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics. RESEARCH DESIGN AND METHODS: All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation. RESULTS: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates. CONCLUSIONS: DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
Authors: Anita Jeyam; Fraser W Gibb; John A McKnight; Joseph E O'Reilly; Thomas M Caparrotta; Andreas Höhn; Stuart J McGurnaghan; Luke A K Blackbourn; Sara Hatam; Brian Kennon; Rory J McCrimmon; Graham Leese; Sam Philip; Naveed Sattar; Paul M McKeigue; Helen M Colhoun Journal: Diabetologia Date: 2021-10-07 Impact factor: 10.122
Authors: Andreas Höhn; Stuart J McGurnaghan; Thomas M Caparrotta; Anita Jeyam; Joseph E O'Reilly; Luke A K Blackbourn; Sara Hatam; Christian Dudel; Rosie J Seaman; Joseph Mellor; Naveed Sattar; Rory J McCrimmon; Brian Kennon; John R Petrie; Sarah Wild; Paul M McKeigue; Helen M Colhoun Journal: PLoS One Date: 2022-08-11 Impact factor: 3.752