AURORA, Colo. (April 21, 2015) – The incidence of a potentially life-threatening
complication of diabetes, called diabetic ketoacidosis, increased by 55 percent
between 1998 and 2012 in youth in Colorado, according to a study by researchers
from the Barbara Davis Center for Childhood Diabetes and the University of
Colorado School of Medicine on the Anschutz Medical Campus.
finding is published in the April 21 issue of JAMA.
ketoacidosis (DKA) at the time of type 1 diabetes diagnosis has detrimental
long-term effects and is characterized by dangerously high blood sugar and the
presence of toxic substances in the blood known as ketones.
symptoms of type 1 diabetes include increased thirst and urination as well as
weight loss. If these symptoms are not recognized and treated early with
insulin injections, the child may develop potentially deadly DKA. DKA requires
costly hospitalization, often in an intensive care unit, and may cause
permanent damage to the brain and other organs.
frequency of DKA in Colorado children and adolescents diagnosed recently has
reached alarming levels,” said lead author Arleta Rewers, MD, PhD, associate
professor of pediatric emergency medicine.
and her colleagues examined trends in DKA at type 1 diabetes diagnosis between
1998 and 2012 in Colorado and factors associated with DKA. During this time
period, youth diagnosed with type 1 diabetes before age 18 years at any medical
facility were included in the study if they were a Colorado resident and
followed up at the Barbara Davis Center for Diabetes, which serves more than 80
percent of youth with diabetes in Colorado.
ketoacidosis was present in 1,339 of 3,439 youth (39 percent) at diagnosis of
type 1 diabetes. Youth with DKA had a median age of 9.4 years, 54 percent were
male, and 76 percent were white. The proportions with DKA increased
significantly, especially after 2007 (30 percent in 1998; 35 percent in 2007;
46 percent in 2012). The only characteristic that changed over time was
insurance, with those covered by public insurance increasing from 17.1 percent
in 2007 to 37.5 percent in 2012.
30 percent of Colorado children presented with DKA,” Rewers said. “Unfortunately,
the rate has increased to 46 percent in 2012, with an especially sharp increase
after 2007. Instead of making progress in early recognition and treatment of
childhood diabetes, our community has reached rates of DKA that are two to
three times higher than in other developed countries.”
authors noted that the incidence of DKA found in this study is consistent with
incidences in countries with poor access to health care and low community and
physician awareness of diabetes, and is much higher than incidences reported in
Canada or the United Kingdom.
of the factors associated with DKA at diagnosis are potentially modifiable,”
they wrote. “For example, the association with family history suggests the
importance of awareness of diabetic symptoms. However, economic factors are
more difficult to modify. Increasing incidence of DKA correlated temporally
with an increase in Colorado child poverty prevalence from 10 percent in 2000
to 18 percent in 2012. The recent increase of DKA incidence among youth with
private insurance may be related to proliferation of high-deductible health
study was supported by a grant from the National Institute of Diabetes and
Digestive and Kidney Diseases and by funding from the Children’s Diabetes Foundation
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