Increase in Prevalence of Diabetic Ketoacidosis at Diagnosis Among Youth With Type 1 Diabetes: The SEARCH for Diabetes in Youth Study
<b>Objective</b>: 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. <p> </p> <p><b>Research Design and Methods</b>: 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. </p> <p> </p> <p><b>Results</b>: 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). </p> <p> </p> <p><b>Conclusions</b>: 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.</p>