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Cited by 348Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review

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Usher-Smith, J. A., Thompson, M. J., Sharp, S. J., Walter, F. M.·2011·BMJ
DOI 10.1136/bmj.d4092PMC PMC3131115
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Abstract

OBJECTIVE: To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults. DESIGN: Systematic review. DATA SOURCES: PubMed, EMBASE, Web of Science, Scopus, and Cinahl and article reference lists. STUDY SELECTION: Cohort studies including unselected groups of children and young adults presenting with new onset type 1 diabetes that distinguished between those who presented in diabetic ketoacidosis and those who did not and included a measurement of either pH or bicarbonate in the definition of diabetic ketoacidosis. There were no restrictions on language of publication. RESULTS: 46 studies involving more than 24,000 children in 31 countries were included. Together they compared 23 different factors. Factors associated with increased risk were younger age (for <2 years old v older, odds ratio 3.41 (95% confidence interval 2.54 to 4.59), for <5 years v older, odds ratio 1.59 (1.38 to 1.84)), diagnostic error (odds ratio 3.35 (2.35 to 4.79)), ethnic minority, lack of health insurance in the US (odds ratio 3.20 (2.03 to 5.04)), lower body mass index, preceding infection (odds ratio 3.14 (0.94 to 10.47)), and delayed treatment (odds ratio 1.74 (1.10 to 2.77)). Protective factors were having a first degree relative with type 1 diabetes at the time of diagnosis (odds ratio 0.33 (0.08 to 1.26)), higher parental education (odds ratios 0.4 (0.20 to 0.79) and 0.64 (0.43 to 0.94) in two studies), and higher background incidence of type 1 diabetes (correlation coefficient -0.715). The mean duration of symptoms was similar between children presenting with or without diabetic ketoacidosis (16.5 days (standard error 6.2) and 17.1 days (6.0) respectively), and up to 38.8% (285/735) of children who presented with diabetic ketoacidosis had been seen at least once by a doctor before diagnosis. CONCLUSIONS: Multiple factors affect the risk of developing diabetic ketoacidosis at the onset of type 1 diabetes in children and young adults, and there is potential time, scope, and opportunity to intervene between symptom onset and development of diabetic ketoacidosis for both parents and clinicians.

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  • Correctly noting diabetic ketoacidosis at diagnosis of type 1 disease represents a key window for survival.

    “and correctly noting diabetic ketoacidosis at diagnosis of type 1 disease represents a key window for survival.37”

    From Type 1 diabetes (2014) · cites this paper as [37]

    The Introduction (page unavailable) says diabetic ketoacidosis at diagnosis can cause life-threatening complications and is the commonest cause of diabetes-related death in children. The Discussion urges clinicians to be alert for it, supporting the importance of recognition, but the review does not establish that correctly identifying it at diagnosis improves survival or extend that conclusion beyond children and young adults. (LLM, conf=0.78)

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Authors
Usher-Smith, J. A., Thompson, M. J., Sharp, S. J., & Walter, F. M.
Affiliations
  • University of Oxford (GB)
  • MRC Epidemiology Unit (GB)
  • University of Cambridge (GB)
ORCID
Venue
BMJ
Publisher
BMJ
Published
2011-07-07
Volume
343
Issue
jul07 1
Pages
d4092-d4092
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.d4092
PMC
PMC3131115
OpenAlex
W2027624649
Cited by
348
References
76
Citations by year
2026: 11 · 2025: 28 · 2024: 35 · 2023: 19 · 2022: 38 · 2021: 30 · 2020: 22 · 2019: 26 · 2018: 20 · 2017: 23 · 2016: 19 · 2015: 21 · 2014: 19 · 2013: 15 · 2012: 15
FWCI
2.37
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health and Care Research
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetic ketoacidosis, type 1 diabetes, children, young adults, risk factors, delayed diagnosis, diagnostic errors, age at diagnosis, ethnic minorities, health insurance, body mass index, infection, family history (medicine), parental education, symptom duration, children's health services, bicarbonate, diabetes self-management
MeSH terms
Adolescent, Age Factors, Child, Child, Preschool, Consanguinity, Diabetes Mellitus, Type 1, Diagnostic Errors, Female, Fever, Humans, Infant, Infections, Insurance, Health, Male, Parents, Patient Acceptance of Health Care, Pedigree, Residence Characteristics, Risk Factors, Seasons, Sex Factors, Socioeconomic Factors, Time Factors, Body Mass Index, Diabetic Ketoacidosis, Young Adult, Delayed Diagnosis

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