Abstract
We assessed the incidence of diabetic ketoacidosis (DKA) in children aged <15 years with newly diagnosed type 1 diabetes mellitus (T1DM) in the Auckland Region (New Zealand) in 1999–2013, in a retrospective review of a complete regional cohort. DKA and its severity were classified according to ISPAD 2014 guidelines. Of 730 children presenting with new-onset T1DM over the 15-year time period, 195 cases had DKA of any severity (27%). There was no change in the incidence of DKA or the proportion of children with severe DKA at presentation. The incidence of DKA among children aged <2.0 years (n = 40) was 53% compared to 25% for those aged 2–14 years (n = 690; p = 0.005). In children aged 2–14 years, increasing age at diagnosis was associated with greater likelihood of DKA at presentation (p = 0.025), with the odds of DKA increasing 1.06 times with each year increase in age. Non-Europeans were more likely to present in DKA than New Zealand Europeans (OR 1.52; p = 0.048). Despite a consistent secular trend of increasing incidence of T1DM, there was no reduction in the incidence of DKA in new-onset T1DM in the Auckland Region over time. Thus, it is important to explore ways to reduce DKA risk.
Highlights
We assessed the incidence of diabetic ketoacidosis (DKA) in children aged < 15 years with newly diagnosed type 1 diabetes mellitus (T1DM) in the Auckland Region (New Zealand) in 1999–2013, in a retrospective review of a complete regional cohort
A total of 955 subjects were diagnosed with diabetes over the study period. 104 were either aged ≥ 15 years or did not reside in the Auckland Region, 90 were cases of type 2 diabetes, and 31 were classified as “other”
Girls were less likely to have mild DKA than boys. In this complete regional population of children newly diagnosed with T1DM, an average of 27% were in DKA at presentation over a 15-year period, but with considerable variation in the annual incidence
Summary
We assessed the incidence of diabetic ketoacidosis (DKA) in children aged < 15 years with newly diagnosed type 1 diabetes mellitus (T1DM) in the Auckland Region (New Zealand) in 1999–2013, in a retrospective review of a complete regional cohort. Of 730 children presenting with new-onset T1DM over the 15-year time period, 195 cases had DKA of any severity (27%). Despite a consistent secular trend of increasing incidence of T1DM, there was no reduction in the incidence of DKA in new-onset T1DM in the Auckland Region over time. Recent meta-analyses suggest that a higher background incidence of T1DM is associated with a lower risk of DKA in children with newly diagnosed T1DM2,8,9. Increase in the incidence of T1DM10,11, there is conflicting evidence on the associated effects on DKA rates. While some longitudinal studies found this increase to be associated with reduced incidence of DKA12,13, others have not[14,15,16]
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