Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study
Open accessAbstract
OBJECTIVE: To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence. METHODS: Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002–2003, 2004–2005, and 2008–2010). Logistic regression was used to determine factors associated with DKA. RESULTS: In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002–2003, 29.1% in 2004–2005, and 31.1% in 2008–2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002–2003 to 5.7% in 2008–2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001). CONCLUSIONS: The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time.
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Children with type 1 diabetes commonly present with polyuria, polydipsia, and weight loss; approximately one third present with diabetic ketoacidosis.
“Children with type 1 diabetes commonly present with symptoms of polyuria, polydipsia, and weight loss; approximately a third present with diabetic ketoacidosis.6”
From Type 1 diabetes (2018) · cites this paper as [6]
The Abstract and Discussion (page unavailable in our copy) report that almost one-third of youth with type 1 diabetes present with DKA. The paper refers generally to signs and symptoms of diabetes, but does not identify polyuria, polydipsia, and weight loss as common presenting symptoms. (LLM, conf=0.90)
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- Authors
- Dabelea, D., Rewers, A., Stafford, J. M., Standiford, D. A., Lawrence, J. M., Saydah, S., Imperatore, G., D’Agostino, R. B., Mayer-Davis, E. J., & Pihoker, C.
- Affiliations
- Colorado School of Public Health (US)
- University of Colorado Anschutz (US)
- Wake Forest University Health Sciences (US)
- Cincinnati Children's Hospital Medical Center (US)
- Kaiser Permanente (US)
- Centers for Disease Control and Prevention (US)
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina; and
- University of Washington (US)
- Corresponding author
- Dabelea, Dana
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2014-04-01
- Volume
- 133
- Issue
- 4
- Pages
- e938-e945
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC4074618
- OpenAlex
- W2148593614
- Cited by
- 417
- References
- 31
- Citations by year
- 2026: 28 · 2025: 32 · 2024: 30 · 2023: 34 · 2022: 42 · 2021: 46 · 2020: 38 · 2019: 43 · 2018: 34 · 2017: 31 · 2016: 23 · 2015: 29 · 2014: 6
- FWCI
- 23.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente (U01 DP000244, DP-05-069, U01 DP000246, 00097, DP000254, U01 DP000247, U01 DP000250, U01 DP000254)
- Medical University of South Carolina
- Wake Forest University (U01 DP000247, U01 DP000246, DP000254, 00097, U01 DP000244, U01 DP000250, DP-05-069, U01 DP000254)
- University of Washington
- University of South Carolina
- National Institutes of Health (UL1TR001082)
- Centers for Disease Control and Prevention (DP‐05‐069, U01DP000244, U01DP000250, U01DP000247, DP000254, U01DP000254, U01DP000246, 00097)
- U.S. Public Health Service (00097)
- University of Colorado Denver (U01 DP000244, U01 DP000254, DP-05-069, DP000254, 00097, U01 DP000246, U01 DP000250, U01 DP000247)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01 DP000250, DP-05-069, U01-DP-000247, U01 DP000248, U01 DP000254, 00097, U01 DP000244, U01-DP-000246, DP000254)
- National Center for Research Resources (M01RR008084, M01RR001271, M01 RR00069, M01 RR-01070, M01RR001070, M01-RR 00037, M01RR000069, M01RR000037, M01-RR-08084)
- National Center for Chronic Disease Prevention and Health Promotion (U01 DP-000247, U01-DP000246, U01-DP-000250, U01-DP-000254, U01 DP000248, DP-05069, U01DP000244)
- National Center for Advancing Translational Sciences
- 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, type 2 diabetes, youth, prevalence trends, SEARCH for Diabetes in Youth, age at diagnosis, racial and ethnic disparities, socioeconomic factors, health insurance, health care access
- MeSH terms
- Adolescent, Child, Child, Preschool, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Infant, Male, Prevalence, Diabetic Ketoacidosis, Young Adult
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