Frequency of ketoacidosis at diagnosis of pediatric type 1 diabetes associated with socioeconomic deprivation and urbanization: Results from the German multicenter DPV registry

Objective

To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes.

Research Design and Methods

Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the prospective diabetes follow-up registry (DPV) were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat), using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization, and if associations differed by age group, sex or migration status. 

Results

In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95%-CI: 19.0-22.4%], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8%] in the most deprived regions (Q5) (P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas), or in cities (27.6% [95%-CI: 26.0-29.3%] vs. 22.7% [21.4-24.0%], P< 0.001, or vs. 24.3% [22.9-25.7%], P= 0.007, respectively). The results did not significantly differ by age group, sex, or migration background, or after additional adjustment for socioeconomic deprivation or urbanization.

Conclusions

This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for pre-symptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.