Predictors of diabetic ketoacidosis in children and adolescents with type 1 diabetes. Experience from a large multicentre database
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OBJECTIVE: Diabetic ketoacidosis (DKA) remains a major cause of hospitalization and death in children and adolescents with established type 1 diabetes despite DKA preventing strategies. The aim of the study was to determine incidence and risk factors for DKA in a large cohort of young diabetic patients. METHODS: This investigation uses the dpv-wiss base containing data on 28 770 patients with type 1 diabetes <20yr, from Germany and Austria. For each patient the most recent year of follow-up was evaluated. DKA was defined as pH < 7.3 and/or hospital admission as a result of DKA, excluding onset DKA. RESULTS: Mean age of the study cohort was 13.96 ± 4.0 yr (47.9% females). A total of 94.1% presented with no episode, 4.9% with 1 episode, and 1.0% with recurrent DKA (≥2). When comparing these three groups, age (p < 0.01), HbA1c (p < 0.01), and insulin dose (p < 0.01) were significantly higher in patients with recurre nt DKA. Incidence of DKA was significantly higher in females (7.3 ± 0.5 vs. 5.8 ± 0.2; p = 0.03) and in patients with migration background (7.8 ± 0.6 vs. 6.3 ± 0.3; p = 0.02). No significant association was found with treatment type and diabetes duration. CONCLUSION: In a cohort of European paediatric diabetic patients, the rate of DKA was significantly higher in females and in children with migration background and early teenage years.
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DKA is often associated with psychosocial challenges, such as disordered eating behaviors, and with periods of transition, such as from pediatric to adult health care when there may be gaps in ambulatory care.
“Notably, the majority of DKA cases occur in those with established diabetes compared with those with newly diagnosed diabetes, often in association with psychosocial challenges, such as disordered eating behaviors, and during periods of transition, such as from pediatric to adult health care when there may be gaps in ambulatory care (186)(187)(188).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [187]
The paper’s introductory passage says most DKA cases occur in patients with previously diagnosed diabetes, and the Discussion links disordered eating and bulimic symptoms to increased DKA risk. The passages do not address transition from pediatric to adult care or gaps in ambulatory care; a search for those terms found no support for that part of the sentence. Page numbers were not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOther factors associated with DKA include age 10-14 years, public insurance, and prior episodes of DKA.
“Other factors associated with DKA include age 10-14 years, public insurance, and prior episodes of DKA; use of insulin pump therapy does not appear to be associated with increased DKA occurrence in the current era.”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [187]
The Results report higher DKA rates for children aged 11–15 at diabetes onset, broadly supporting the age association but not the stated 10–14-year range. The Discussion mentions underinsurance in previous studies, not public insurance, and the Results count recurrent DKA episodes without establishing prior episodes as a predictor of later DKA. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe majority of DKA cases occur in those with established diabetes compared with those with newly diagnosed diabetes.
“Notably, the majority of DKA cases occur in those with established diabetes compared with those with newly diagnosed diabetes, often in association with psychosocial challenges, such as disordered eating behaviors, and during periods of transition, such as from pediatric to adult health care when there may be gaps in ambulatory care (186)(187)(188).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [187]
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Self-citation
- Authors
- Fritsch, M., Rosenbauer, J., Schober, E., Neu, A., Placzek, K., Holl, R. W., & for the German Competence Network Diabetes Mellitus and the DPV Initiative
- Affiliations
- Medical University of Vienna (AT)
- Deutsches Diabetes-Zentrum e.V. (DE)
- University Children's Hospital Tübingen (DE)
- Martin Luther University Halle-Wittenberg (DE)
- Universität Ulm (DE)
- Corresponding author
- Fritsch, Maria
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2011-04-06
- Volume
- 12
- Issue
- 4pt1
- Pages
- 307-312
- ISSN
- 1399-543X (ISSN-L)
- OpenAlex
- W2071590537
- Semantic Scholar
- d2b75788053ec93f11627193d1b97db867ef2651
- Cited by
- 93
- References
- 24
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 9 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 10 · 2015: 9 · 2014: 3 · 2013: 8 · 2012: 6
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Foundation for the Study of Diabetes
- Bundesministerium für Bildung und Forschung
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- diabetic ketoacidosis, type 1 diabetes, children and adolescents, risk factors, incidence, HbA1c, insulin dose, sex differences, migration background, diabetes duration, treatment type
- MeSH terms
- Adolescent, Age Factors, Austria, Child, Diabetes Mellitus, Type 1, Emigration and Immigration, Female, Germany, Glycated Hemoglobin, Humans, Insulin, Male, Incidence, Diabetic Ketoacidosis, Age of Onset
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