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Increase in Prevalence of Diabetic Ketoacidosis at Diagnosis Among Youth With Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

posted on 07.06.2021, 17:39 by Elizabeth T Jensen, Jeanette M Stafford, Sharon Saydah, Ralph B D'Agostino, Jr, Lawrence M Dolan, Jean M Lawrence, Santica Marcovina, Elizabeth J Mayer-Davis, Catherine Pihoker, Arleta Rewers, Dana Dabelea
Objective: We previously reported a high (~30%), but stable prevalence of DKA at youth-onset diagnosis of type 1 diabetes (2002 and 2010). Given the changing demographics of youth-onset type 1 diabetes, we sought to evaluate temporal trends in the prevalence of DKA at diagnosis of type 1 diabetes from 2010 to 2016 among youth <20 years of age and evaluate whether any change observed was associated with changes in sociodemographic distribution of those recently diagnosed.

Research Design and Methods: We calculated prevalence of DKA within 1 month of type 1 diabetes diagnosis by year and evaluated trends over time (2010-2016) (n=7,612 incident diabetes cases, mean (SD) age 10.1 (4.5) at diagnosis). To assess whether trends observed were attributable to the changing distribution of sociodemographic factors among youth with incident type 1 diabetes, we estimated an adjusted relative risk (aRR) of DKA in relation to calendar year, adjusting for age, sex, race/ethnicity, income, education, health insurance status, language, season of diagnosis, and SEARCH site.

Results: DKA prevalence increased from 35.3% (95% CI: 32.2, 38.4) in 2010, to 40.6% (95% CI: 37.8, 43.4) in 2016 (p for trend=0.01). Adjustment for sociodemographic factors did not substantively change the observed trends. We observed a 2% annual increase in prevalence of DKA at or near diagnosis of type 1 diabetes (crude RR: 1.02; 95% CI: 1.01, 1.04 and aRR: 1.02; 95% CI: 1.01, 1.04; p=0.01 for both).

Conclusions: Prevalence of DKA at or near type 1 diabetes diagnosis has increased from 2010 to 2016, following the high but stable prevalence observed from 2002-2010. This increase does not seem to be attributable to the changes in distribution of sociodemographic factors over time.


The SEARCH for Diabetes in Youth Cohort Study (1UC4DK108173-01) is funded by the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention (CDC). The Population Based Registry of Diabetes in Youth Study (RFP DP15-002) is funded by the CDC and supported by the NIH, National Institute of Diabetes and Digestive and Kidney Diseases. Sites: Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado–Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), and Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases.