Too Often, Pediatric Type 1 Diabetes Missed Until DKA Crisis

Marlene Busko

April 09, 2014

Nearly 1 in 3 American children diagnosed with type 1 diabetes presents with diabetic ketoacidosis (DKA), according to a study published online March 31 in Pediatrics. Rates of DKA — a preventable but potentially life-threatening condition caused by a severe lack of insulin — have dropped in children with newly diagnosed with type 2 diabetes, but DKA is less common in this form of diabetes.

These findings in pediatric type 1 diabetes are "concerning, especially given the risk factors we've identified for this acute complication — minority racial/ethnic group, younger age, and lack of private insurance," lead author Dana Dabelea, MD, from the Colorado School of Public Health, in Aurora, told Medscape Medical News. "That just means we have much more to do" to lower the rate of DKA at diagnosis by means of educational programs to increase awareness in the community and by improving access to care.

"The most common signs and symptoms of type 1 diabetes are thirst (polydipsia), frequent urination (polyuria), and weight loss," she noted. These signs can be hard to identify in a toddler, for example, but families need to look for this, especially if there is a family history of diabetes. Physicians need to help parents recognize these signs "so that even if diabetes is diagnosed, it does not have to be diagnosed by a coma or such an acute presentation."

SEARCHing for DKA Prevalence

DKA is preventable, but many parents and youth don't recognize the signs and symptoms of diabetes, and instead, DKA triggers a diagnosis of diabetes, Dr. Dabelea and colleagues write.

To examine the prevalence of DKA at diagnosis of diabetes over the past several years, they looked at registry data from the SEARCH for Diabetes in Youth study, the largest surveillance study of new cases of childhood diabetes in the United States. SEARCH, which began in 2002, enrolls youth (infants through age 19 years) who live in Ohio, Washington, South Carolina, and Colorado or belong to a health plan in Southern California or are American Indians living in Arizona and New Mexico.

The researchers analyzed data from 5615 youth who were diagnosed with type 1 diabetes and 1425 youth who were diagnosed with type 2 diabetes from 2002 to 2010 and were included in the database.

DKA Rates Differ With Type 1 and Type 2 Diabetes

Among the youth with type 2 diabetes, the prevalence of DKA at the time of diagnosis of diabetes decreased from 11.7% in 2002–2003 to 5.7% in 2008–2010. This improvement may be a benefit of earlier diagnosis brought about by greater awareness. "It seems like in the last 15 years we're only talking about type 2 diabetes in children, and [yet] type 1 diabetes remains the major form" of diabetes in the pediatric population, Dr. Dabelea observed.

In the children with type 2 diabetes, DKA was significantly more common among 10- to 14-year-olds (as opposed to 15- to 19-year-olds), boys, and children who belonged to a minority race.

In the children with type 1 diabetes, on the other hand, the prevalence of DKA at the time of diabetes diagnosis has remained high and stable: 30.2%, 29%, and 31.1%, during 2002–2003, 2004–2005, and 2008–2010, respectively.

Children with type 1 diabetes were significantly more likely to have DKA if they were 4 years old or younger or Hispanic or African American or came from families with a low income or without private health insurance.

A US national program to increase awareness of DKA might help lower these rates, Dr. Dabelea noted. The rates of DKA in Sweden and Finland, which were already low, dropped further after the countries introduced awareness programs.

Greater efforts are needed to ensure that the underserved groups identified in this study have better access to healthcare. "With changes in the availability of health insurance and associated healthcare access on the horizon, it may be possible to begin reducing DKA rates in the near future, although it is likely that additional outreach to minority populations will be needed to decrease DKA in these groups," the authors conclude.

The authors have reported no relevant financial relationships.

Pediatrics. Published online March 31, 2014. Abstract

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