15-year incidence of new-onset diabetic ketoacidosis in children with type 1 diabetes from a regional paediatric setting (Auckland, New Zealand)

  • Craig Jefferies
  • Samuel Cutfield
  • José GB Derraik
  • Jignal Bhagvandas
  • Benjamin B Albert
  • Paul L Hofman
  • Alistair J Gunn
  • Wayne S Cutfield
Open Access
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Keywords

Child Health Retrospective Review Paediatric Population Female Gender Annual Incidence 

Aims

This study aimed to assess the incidence of new-onset diabetic ketoacidosis (DKA) incidence over a 15-year period in children with type 1 diabetes (T1DM) from our regional paediatric diabetes centre in Auckland, New Zealand.

Methods

We performed a retrospective review of all patients <15 years of age diagnosed with T1DM from our unselected complete regional cohort for the years 1999 to 2013. Children were included if they had type 1 diabetes as defined by clinical presentation and/or DKA and/or presence of pre-type 1 diabetes autoantibodies. DKA was classified into Mild (pH <7.3 bicarbonate <15), Mod (pH <7.2 bicarbonate <10), and severe (pH <7.1 bicarbonate <5), according to the ISPAD guidelines.

Results

For the 15-year period, there were 731 children <15 years with new-onset T1DM, 343 (47%) males, there were 195 (26.7%) cases of new-onset DKA: 51 (26%) severe, 52 (27%) moderate, and 92 (47%) with mild DKA. Average age at diagnosis was 8.6 years. The annual incidence of DKA was variable, ranging from 18% to 37%. The overall incidence of new-onset DKA did not differ over the study interval (p=0.78). The likelihood of being in DKA at onset of T1DM was unaffected by age, sex, ethnicity, or socio-economic status. Amongst those in DKA, New Zealand European ethnicity (p=0.038) and female gender (p=0.056) were each associated with increasing DKA severity at presentation.

Conclusions

There has been a stable but persistent level of New-onset DKA over the 15-year period studied in our regional paediatric population. Action must be taken to improve awareness of T1DM and in doing so, reduce the incidence of new-onset DKA.

Copyright information

© Jefferies et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Craig Jefferies
    • 1
  • Samuel Cutfield
    • 2
  • José GB Derraik
    • 2
  • Jignal Bhagvandas
    • 1
  • Benjamin B Albert
    • 2
  • Paul L Hofman
    • 2
    • 4
  • Alistair J Gunn
    • 3
  • Wayne S Cutfield
    • 2
    • 4
  1. 1.Starship Children’s HospitalAucklandNew Zealand
  2. 2.Liggins InstituteUniversity of AucklandAucklandNew Zealand
  3. 3.Department of PhysiologyUniversity of AucklandAucklandNew Zealand
  4. 4.Gravida National centre for growth and developmentAucklandNew Zealand

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