Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1258-e1266 (doi:10.1542/peds.2007-1105)

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ARTICLE

Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study

Arleta Rewers, MD, PhD^a, Georgeanna Klingensmith, MD^a, Cralen Davis, PhD^b, Diana B. Petitti, MD^c, Catherine Pihoker, MD^d, Beatriz Rodriguez, MD^e, I. David Schwartz, MD^f, Giuseppina Imperatore, MD, PhD^g, Desmond Williams, MD^g, Lawrence M. Dolan, MD^h and Dana Dabelea, MD, PhDⁱ

^a Departments of Pediatrics
ⁱ Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
^b Department of Public Health Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
^c Kaiser Permanente Southern California, Pasadena, California
^d Children's Hospital and Regional Medical Center, Seattle, Washington
^e Pacific Health Research Institute, Honolulu, Hawaii
^f Department of Pediatrics, University of South Carolina, Columbia, South Carolina
^g Centers for Disease Control and Prevention, Atlanta, Georgia
^h Children's Hospital Medical Center, Cincinnati, Ohio

OBJECTIVE. The purpose of this work was to determine the prevalence and predictors of diabetic ketoacidosis at the diagnosis of diabetes in a large sample of youth from the US population.

PATIENTS AND METHODS. The Search for Diabetes in Youth Study, a multicenter, population-based registry of diabetes with diagnosis before 20 years of age, identified 3666 patients with new onset of diabetes in the study areas in 2002–2004. Medical charts were reviewed in 2824 (77%) of the patients in a standard manner to abstract the results of laboratory tests and to ascertain diabetic ketoacidosis at the time of diagnosis. Diabetic ketoacidosis was defined by blood bicarbonate <15 mmol/L and/or venous pH < 7.25 (arterial/capillary pH < 7.30), International Classification of Diseases, Ninth Revision, code 250.1, or listing of diabetic ketoacidosis in the medical chart.

RESULTS. More than half (54%) of the patients were hospitalized at diagnosis, including 93% of those with diabetic ketoacidosis and 41% without diabetic ketoacidosis. The prevalence of diabetic ketoacidosis at the diagnosis was 25.5%. The prevalence decreased with age from 37.3% in children aged 0 to 4 years to 14.7% in those aged 15 to 19 years. Diabetic ketoacidosis prevalence was significantly higher in patients with type 1 (29.4%) rather than in those with type 2 diabetes (9.7%). After adjusting for the effects of center, age, gender, race or ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education.

CONCLUSION. At the time of diagnosis, 1 in 4 youth presents with diabetic ketoacidosis. Those with diabetic ketoacidosis were more likely to be hospitalized. Diabetic ketoacidosis was a presenting feature of <10% of youth with type 2. Young and poor children are disproportionately affected.

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Key Words: ketoacidosis • adolescent • children • diabetes • type 1 diabetes • type 2 diabetes

Abbreviations: DKA—diabetic ketoacidosis • SEARCH—Search for Diabetes in Youth • IRB—institutional review board • AIC—Akaike information criterion • CI—confidence interval • OR—odds ratio

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Accepted Nov 5, 2007.

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