Prevalence of Diabetic Ketoacidosis at Diagnosis

A recent analysis of youth with type 1 or type 2 diabetes shows that the incidence of DKA continues to be high…. 

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes caused by the build-up of ketone bodies secondary to insulin deficiency. While it occurs predominantly in type 1 diabetic patients, at the time of diagnosis, it can also happen in type 2 diabetes when medications are inadequately managed.

Using data from the registry component of the SEARCH for Diabetes in Youth Study, researchers estimated temporal changes in the prevalence of diabetic ketoacidosis at the time of diagnosis of type 1 and type 2 diabetes. Researchers assessed the trend in the prevalence of diabetic ketoacidosis over 3 time period by calculating the period prevalence of diabetic ketoacidosis at diagnosis with 95% confidence intervals based on age group, gender and ethnicity/race. Logistic regression was used to analyze factors associated with diabetic ketoacidosis.

A total of 5,615 youth with type 1 diabetes and 1,425 with type 2 diabetes were included in the analysis. Diabetic ketoacidosis was defined as a bicarbonate level of less than15 mmol/L and/or a venous pH of less than 7.25 or an arterial or capillary pH of less than 7.30.

The prevalence of DKA type 1 diabetic youth was stable having a P-trend=0.42 (CI=95%) with prevalence of 30.2%, 29.1% and 31.1% during the years 2002-2003, 2004-2005 and 2008-2010, respectively). Prevalence was notably higher in those diagnosed at a younger age (P<0.0001), with the overall prevalence being highest in those between the ages of 0 and 4 (~39%) and lowest in those between the ages of 15 and 19 years old (~23%). Researchers found the prevalence of diabetic ketoacidosis to be higher in those of minority race (P=0.019) and low income (P=0.019). In household earning between $25,000 and $49,000, the odds of having diabetic ketoacidosis were significantly higher compared to households earning between $50,000 to $74,000.

In those with type 2 diabetes, the prevalence of diabetic ketoacidosis decreased from 11.7% to 5.7% in 2002–2003 and 2008–2010, respectively (P-trend= 0.005, CI=95%). Higher prevalence was associated with younger age at diagnosis (P = 0.001), minority race/ethnicity (P= 0.013), and those of male gender (P = 0.001).

Although the frequency of diabetic ketoacidosis in type 1 diabetics remained stable throughout this study, it was relatively high. This may indicate the need for practitioners to education patients at risk of diabetes of the signs and symptoms. Further, results of this study may indicate that better access to health care may result in an early diagnosis of diabetes and resulting decrease prevalence of diabetic ketoacidosis at time of diagnosis.

Practice Pearls:

• Diabetic ketoacidosis is a dangerous condition most commonly associated with new type 1 diabetic patients
• The frequency of diabetic ketoacidosis at time of diagnosis remains stable yet high
• Increasing access to health care providers and educating patients at risk for diabetes about the signs and symptoms of diabetic ketoacidosis may help to increase awareness and decrease the overall prevalence of this condition

Dabelea D, Rewers A, Stafford JM, et al. Trends in the Prevalence of Ketoacidosis at Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study. Pediatrics. 2014;133(4):e938-45.