AURORA, Colo. (April 21, 2015) - The incidence of a potentially life-threatening complication of diabetes, called diabetic ketoacidosis, increased by 55 percent between 1998 and 2012 in youth in Colorado, according to a study by researchers from the Barbara Davis Center for Childhood Diabetes and the University of Colorado School of Medicine on the Anschutz Medical Campus.
The finding is published in the April 21 issue of JAMA.
Diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis has detrimental long-term effects and is characterized by dangerously high blood sugar and the presence of toxic substances in the blood known as ketones.
Typical symptoms of type 1 diabetes include increased thirst and urination as well as weight loss. If these symptoms are not recognized and treated early with insulin injections, the child may develop potentially deadly DKA. DKA requires costly hospitalization, often in an intensive care unit, and may cause permanent damage to the brain and other organs.
"The frequency of DKA in Colorado children and adolescents diagnosed recently has reached alarming levels," said lead author Arleta Rewers, MD, PhD, associate professor of pediatric emergency medicine.
Rewers and her colleagues examined trends in DKA at type 1 diabetes diagnosis between 1998 and 2012 in Colorado and factors associated with DKA. During this time period, youth diagnosed with type 1 diabetes before age 18 years at any medical facility were included in the study if they were a Colorado resident and followed up at the Barbara Davis Center for Diabetes, which serves more than 80 percent of youth with diabetes in Colorado.
Diabetic ketoacidosis was present in 1,339 of 3,439 youth (39 percent) at diagnosis of type 1 diabetes. Youth with DKA had a median age of 9.4 years, 54 percent were male, and 76 percent were white. The proportions with DKA increased significantly, especially after 2007 (30 percent in 1998; 35 percent in 2007; 46 percent in 2012). The only characteristic that changed over time was insurance, with those covered by public insurance increasing from 17.1 percent in 2007 to 37.5 percent in 2012.
"Historically, 30 percent of Colorado children presented with DKA," Rewers said. "Unfortunately, the rate has increased to 46 percent in 2012, with an especially sharp increase after 2007. Instead of making progress in early recognition and treatment of childhood diabetes, our community has reached rates of DKA that are two to three times higher than in other developed countries."
The authors noted that the incidence of DKA found in this study is consistent with incidences in countries with poor access to health care and low community and physician awareness of diabetes, and is much higher than incidences reported in Canada or the United Kingdom.
"Some of the factors associated with DKA at diagnosis are potentially modifiable," they wrote. "For example, the association with family history suggests the importance of awareness of diabetic symptoms. However, economic factors are more difficult to modify. Increasing incidence of DKA correlated temporally with an increase in Colorado child poverty prevalence from 10 percent in 2000 to 18 percent in 2012. The recent increase of DKA incidence among youth with private insurance may be related to proliferation of high-deductible health plans."
This study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases and by funding from the Children's Diabetes Foundation in Denver.
About the University of Colorado School of Medicine
Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at University of Colorado Health, Children's Hospital Colorado, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. The school is located on the Anschutz Medical Campus, one of four campuses in the University of Colorado system. To learn more about the medical school's care, education, research and community engagement, visit its web site.