Event Rates and Risk Factors for the Development of Diabetic Ketoacidosis in Adult Patients With Type 1 Diabetes: Analysis From the DPV Registry Based on 46,966 Patients
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) that results from absolute insulin deficiency and is marked by acidosis, ketosis, and hyperglycemia (1). Therefore, prevention of DKA is one goal in T1DM care, but recent data indicate increased incidence (2). For adult patients, only limited data are available on rates and risk factors for development of DKA, and this complication remains epidemiologically poorly characterized. The Diabetes Prospective Follow-up Registry (DPV) has followed patients with diabetes from 1995. Data for this study were collected from 2000 to 2016. Inclusion criteria were diagnosis of T1DM, age at diabetes onset ≥6 months, patient age at follow-up ≥18 years, and diabetes duration ≥1 year to exclude DKA at manifestation. DKA was defined as serum pH <7.3, and rates of DKA were analyzed based on a Poisson regression model accounting for overdisperson stratified by sex, age, diabetes duration, HbA1c, treatment regimen, size of diabetes center, and migration background, i.e., whether the patient or one or both parents were born outside the countries of the registry. A diabetes center that treated ≥50 adult patients with T1DM in the year 2016 was considered large. In total, 46,966 patients were included in this study (average age 38.5 years [median 21.2], …
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In a European registry, adults with type 1 diabetes had DKA at a rate of 2.5 per 100 patient-years.
“In a European (predominantly Germany and Austria) registry, adults with type 1 diabetes had DKA at a rate of 2.5 per 100 patient-years (210).”
Some known risk factors for DKA are nonmodifiable, such as low socioeconomic status, younger age, female sex, and ethnicity.
“Some known risk factors are nonmodifiable, such as low socioeconomic status, younger age, female sex, and ethnicity (41,210)”
More recent studies have not found a higher risk of DKA in those using insulin pumps.
“However, more recent studies have not found this to be the case (41,210,215).”
Cites
Karges, B., Rosenbauer, J., Holterhus, P.-M., Beyer, P., Seithe, H., Vogel, C., Böckmann, A., Peters, D., Müther, S., Neu, A., et al. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0129 · Cited by 129 · see citing works
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Holt, R. I. G., DeVries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., et al. (2021) · Diabetes Care · doi:10.2337/dci21-0043 · Cited by 699 · see citing works
Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0165-1 · Cited by 461 · see citing works
Ehrmann, D., Kulzer, B., Roos, T., Haak, T., Al-Khatib, M., & Hermanns, N. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30042-5 · Cited by 141 · see citing works
- Authors
- Kalscheuer, H., Seufert, J., Lanzinger, S., Rosenbauer, J., Karges, W., Bergis, D., Mader, J. K., Zimny, S., Schmid, S. M., Hummel, M., Kerner, W., & Holl, R. W.
- Affiliations
- University of Lübeck (DE)
- University of Freiburg (DE)
- Universität Ulm (DE)
- Deutsches Diabetes-Zentrum e.V. (DE)
- Section of Endocrinology and Diabetology, RWTH Aachen University, Aachen, Germany
- University Hospital Frankfurt (DE)
- Medical University of Graz (AT)
- Helios Hospital Schwerin (DE)
- German Center for Diabetes Research (DE)
- Specialized Diabetes Practice, Rosenheim, Germany
- Institute for Diabetes Gerhardt Katsch (DE)
- Corresponding author
- Kalscheuer, Hannes
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-01-17
- Volume
- 42
- Issue
- 3
- Pages
- e34-e36
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2909710308
- Cited by
- 40
- References
- 1
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 3
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- 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, adult patients, incidence, risk factors, insulin deficiency, HbA1c, diabetes duration, migration background
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