Details

Autor(en) / Beteiligte

• Duca, Lindsey M
• Wang, Bing
• Rewers, Marian
• Rewers, Arleta

Titel

Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control

Ist Teil von

• Diabetes care, 2017-09, Vol.40 (9), p.1249-1255

Ort / Verlag

United States: American Diabetes Association

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• This study tested the hypothesis that diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control independently of established risk factors. This was a prospective cohort study of 3,364 Colorado residents diagnosed with type 1 diabetes before 18 years of age, in 1998-2012, and monitored for up to 15 years. Of those, 1,297 (39%) had DKA at diagnosis (blood glucose >250 mg/dL, and venous pH <7.3 or bicarbonate <15 mEq/L). Severity of DKA was further classified as mild/moderate (pH 7.10-7.29 or bicarbonate 5-14 mEq/L) or severe (pH <7.10 or bicarbonate <5 mEq/L). HbA levels were measured an average of 2.8 times/year (median 20 HbA values/patient). A linear mixed model was used to examine the effect of DKA on long-term HbA levels, adjusting for age, race/ethnicity, sex, family history of diabetes, health insurance, and insulin pump use. DKA at diagnosis predicted persistently elevated HbA levels. Compared with children without DKA, HbA tracked 1.4% (15.3 mmol/mol) higher in those with severe DKA ( < 0.0001) and 0.9% (9.8 mmol/mol) higher in those with mild/moderate DKA at diagnosis ( < 0.0001). These effects were independent of ethnic minority status or lack of health insurance at diagnosis that predicted higher HbA by 0.5% (5.5 mmol/mol; < 0.0001) and 0.2% (2.2 mmol/mol; < 0.0001), respectively. Insulin pump use or having a parent or sibling with type 1 diabetes predicted lower long-term HbA by, respectively, 0.4% (4.4 mmol/mol; < 0.0001) and 0.2% (2.2 mmol/mol; = 0.01). DKA at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control, independent of demographic and socioeconomic factors.