Diabetic ketoacidosis at diagnosis in Austrian children in 1989-2008: a population-based analysis

• Published in: Diabetologia Vol. 53; no. 6; pp. 1057 - 1061
• Main Authors: Schober, E, Rami, B, Waldhoer, T
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01-06-2010; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Acidosis; Adolescent; Age; Age Factors; Age of Onset; Austria - epidemiology; Biological and medical sciences; Blood Glucose; Body mass index; Child; Child, Preschool; children; Children & youth; Diabetes; Diabetes manifestation; Diabetes Mellitus, Type 1 - diagnosis; Diabetes. Impaired glucose tolerance; Diabetic ketoacidosis; Diabetic Ketoacidosis - diagnosis; Diabetic Ketoacidosis - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose; Human Physiology; Humans; Hyperventilation; Incidence; Infant; Infant, Newborn; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Prevalence; Prospective Studies; Regression Analysis; Severity of Illness Index; Time trend; Trends; Type 1 diabetes mellitus; Variables; Austria; Time trend; Austria; Children; Diabetes manifestation; Diabetic ketoacidosis; Type 1 diabetes mellitus; Endocrinopathy; Human; Immunopathology; Autoimmune disease; Acid base balance disorder; Metabolic disorder; Type 1 diabetes; Ketoacidosis; Diagnosis; Child
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-010-1704-1

Aim The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989-2008) on a population basis in the whole of Austria. Methods A prospective population-based incidence study (1989-2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH < 7.3 and severe DKA as pH < 7.1. Time trends were estimated using linear regression models. Results During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p < 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p < 0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/100,000 (p < 0.0001), no significant change in the prevalence of DKA at manifestation was observed. Conclusions The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset.