Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes and Glycemic Control over Time: The SEARCH for Diabetes in Youth Study

Details

• Alternative Title:
  Pediatr Diabetes
• Personal Author:
  Duca, Lindsey M ; Reboussin, Beth A ; Pihoker, Catherine ; Imperatore, Giuseppina ; Saydah, Sharon ; Mayer-Davis, Elizabeth ; Rewers, Arleta ; Dabelea, Dana
• Description:
  Background:
  
  The diagnosis of type 1 diabetes (T1D) in youth is often associated with diabetic ketoacidosis (DKA). We aimed to evaluate if the presence of DKA at diagnosis of T1D is associated with less favorable hemoglobin A1c (HbA1c) trajectories over time.
  
  Methods:
  
  The SEARCH for Diabetes in Youth study of 1396 youth aged <20 years with newly diagnosed T1D were followed for up to 13 [median 8 (IQR 6-9)] years post-diagnosis. Of these, 397 (28%) had DKA (bicarbonate level<15 mmol/l and/or pH<7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in medical records) at diabetes onset. Longitudinal HbA1c levels were measured at each follow-up visit (average number of HbA1c measures 3.4). A linear piecewise mixed effects model was used to analyze the effect of DKA status at diagnosis of T1D on long-term glycemic control, adjusting for age at diagnosis, diabetes duration at baseline, sex, race/ethnicity, household income, health insurance status, time-varying insulin regimen and glucose self-monitoring, study site, and baseline fasting C-peptide level.
  
  Results:
  
  At baseline, HbA1c levels were significantly higher in youth with T1D diagnosed in DKA versus those who were not (9.9%±1.5% vs. 8.5%±1.4%, respectively). After the first year with diabetes, there was a significant difference in the rate of change in HbA1c levels by DKA status: HbA1c was 0.16% higher each year in youth with DKA compared to those without (interaction p-value<.0001), after adjusting for aforementioned covariates.
  
  Conclusion/interpretation:
  
  DKA at T1D diagnosis is associated with worsening glycemic control over time, independent of demographic, socioeconomic and treatment-related factors and baseline fasting C-peptide.
  
  
• Subjects:
  Adolescent Blood Glucose Blood Glucose Self-Monitoring Child Child, Preschool Diabetes Mellitus, Type 1 Diabetic Ketoacidosis Female Follow-Up Studies Glycated Hemoglobin Humans Male Prognosis Self Efficacy Time Factors

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• Keywords:
  Diabetic Ketoacidosis Glycemic Control Type 1 Diabetes
• Source:
  Pediatr Diabetes. 20(2):172-179
• Pubmed ID:
  30556249
• Pubmed Central ID:
  PMC6361710
• Document Type:
  Journal Article
• Funding:
  P30 DK057516/DK/NIDDK NIH HHSUnited States/ ; UC4 DK108173/DK/NIDDK NIH HHSUnited States/ ; U18 DP002710/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006134/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006138/DP/NCCDPHP CDC HHSUnited States/ ; UL1 TR000154/TR/NCATS NIH HHSUnited States/ ; U18 DP002714/DP/NCCDPHP CDC HHSUnited States/ ; U01 DP000248/DP/NCCDPHP CDC HHSUnited States/ ; U01 DP000244/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006139/DP/NCCDPHP CDC HHSUnited States/ ; UL1 TR000423/TR/NCATS NIH HHSUnited States/ ; U01 DP000250/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP002708/DP/NCCDPHP CDC HHSUnited States/ ; P30 DK017047/DK/NIDDK NIH HHSUnited States/ ; U01 DP000247/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP003256/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006131/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006136/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP002709/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006133/DP/NCCDPHP CDC HHSUnited States/ ; UL1 TR001425/TR/NCATS NIH HHSUnited States/ ; UL1 TR002319/TR/NCATS NIH HHSUnited States/ ; U01 DP000246/DP/NCCDPHP CDC HHSUnited States/ ; UL1 TR001450/TR/NCATS NIH HHSUnited States/ ; U01 DP000254/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  20
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:c2e2bd602756ea57b438eade33a1a4ec077f53edb55c8f341fd6f8e95bc07cee9d01724049a05490e9291180740af7649b9925cce107e7dbf1afaa282f108234
• Download URL:
  https://stacks.cdc.gov/view/cdc/75635/cdc_75635_DS1.pdf
• File Type:
  [PDF - 399.07 KB ]