Risk & Protective Factors
It is unclear why some children present in DKA and others do not. Bui et al. hypothesize that the development of DKA may be the consequence of missed diagnoses and treatment.[24] Neu et al. suggest variations in disease subtypes and more aggressive forms of diabetes.[25] Several risk factors were found to be associated with DKA presentations. A recent systematic review of 46 studies (involving ~24,000 children in 31 countries and 735 DKA episodes) published by Usher-Smith et al. found the following risk factors at new-onset T1DM diagnosis:[15]
Younger age (<5 years)
Diagnostic error
Ethnic minority
Lack of health insurance (a finding reported in the USA)
Lower BMI
Preceding infection
Delayed treatment
Another study by Flood et al. suggests that infections as a risk factor is uncommon and should be further investigated only if fever or other signs of illness are present.[26]
Protective factors include the following:[15]
First-degree relative with T1DM
Higher parental education
Higher background incidence of T1DM
Enrollment in T1DM research studies[14]
For established T1DM patients, the risk of DKA is 1–10% per patient-year.[3,27] The risk is increased for:[19]
Poor metabolic control
Previous DKA episode
Peripubertal and adolescent girls
Children with psychiatric disorders, including eating disorders
Children with difficult psychosocial backgrounds
Limited access to medical services
Insulin omission[28]
Insulin pump therapy[20]
Expert Rev Endocrinol Metab. 2012;7(4):433-443. © 2012 Expert Reviews Ltd.
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