Increased Screening, Education Levels Could Decrease Risk of DKA at T1D Onset in Pediatric Diabetes

A systematic review and meta-analysis from a team of investigators in the United Kingdom is providing clinicians with an overview of factors associated with increased and decreased risk of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes in pediatric patients.

Results of the study, which included data from 195 published works encompassing more than 185,000 pediatric patients from 47 countries, suggest multiple factors, including younger age and belonging to an ethnic minority population, were associated with an increased risk while having a family history of type 1 diabetes and higher level of parental education were associated with a decreased risk of presenting with DKA at onset of type 1 diabetes.

“This systematic review provides up-to-date data on the associations between risk factors and the presence of DKA at T1D onset. The results demonstrated that individuals at greatest risk of DKA included young children, individuals with delayed or missed diagnoses, those belonging to ethnic minority groups, and those with presentation during the COVID-19 pandemic,” wrote investigators.

Among the most common diabetes-related emergencies for people with type 1 diabetes, DKA represents one of the most prevalent threats to overall wellbeing for those with pediatric type 1 diabetes. Looking to build on data from a systematic review published in 2011 systematic review, the current research endeavor was led by Daniel B. Hawcutt, MBChB, MD, of the University of Liverpool, and a team of colleagues from multiple institutions in the UK.

In the 2011 systematic review, which included 46 studies involving more than 24,000 children in 31 countries, results indicated young age, diagnostic error, and belonging to an ethnic minority group as key factors associated with DKA at first presentation of T1D. In the current study, investigators hoped to provide an update to the findings from the 2011 systematic review by performing their own systematic review and meta-analysis.

With this in mind, investigators performed a search of the PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for studies on DKA and type 1 diabetes onset among people younger than 18 years of age published from January 2011-November 2021. A random-effects model was used to estimate associations between factors of interest and DKA at onset of type 1 diabetes using data obtained from this study combined with data from the 2011 systematic review.

From their search, investigators identified 149 articles with data from 188,637 pediatric patients across 47 different countries for inclusion. Combined with the published works included in the 2011 systematic review, the investigators’ systematic review included 195 studies. From these studies, 38 factors were identified for inclusion in the investigators’ analyses.

Upon analysis, results indicated a younger age at onset (less than 2 years vs 2 or more years; odds ratio [OR], 3.51 [95% CI, 2.85-4.32]; P <.001) and belonging to an ethnic minority population (OR, 0.40 [95% CI, 0.21-0.74]; P=.004) were associated with an increased risk of DKA at onset of type 1 diabetes, which investigators noted was consistent with the 2011 systematic review. Investigators pointed out delayed diagnosis (OR, 2.27 [95% CI, 1.72-3.01]; P < .001) and presentation during the COVID-19 pandemic (OR, 2.32 [95% CI, 1.76-3.06]; P <.001) were identified as factors associated with increased risk of DKA at onset of type 1 diabetes in present analyses, but not in the 2011 systematic review. Results indicated a family history of type 1 diabetes (OR, 0.46 [95% CI, 0.37-0.57]; P < .001) and participation in screening programs (OR, 0.35 [95% CI, 0.21-0.59]; P <.001) were associated with a decreased risk of DKA with type 1 diabetes at diagnosis.

“A strategy to achieve reduced DKA may include screening of national populations to identify those at greatest risk. However, with the potential for considerable psychological and economic burden, the beneficence of this strategy should be assessed carefully,” investigators added. “In addition, although some educational campaigns were shown to be associated with reduced DKA incidence, they should be targeted appropriately to have greatest influence.”

This study, “Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients,” was published in JAMA Pediatrics.