Diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado children, 2010-2017

Alonso, G. Todd; Coakley, Alex; Pyle, Laura; Manseau, Katherine; Thomas, Sarah; Rewers, Arleta

doi:10.2337/dc19-0428

Cited by 117Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado children, 2010-2017

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Alonso, G. Todd, Coakley, Alex, Pyle, Laura, Manseau, Katherine, Thomas, Sarah, Rewers, Arleta·2020·Diabetes Care

DOI 10.2337/dc19-0428PMC PMC6925579

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Abstract

OBJECTIVE We examined trends in diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes at a large pediatric diabetes center between 2010 and 2017, overlapping with the Affordable Care Act’s overhaul of U.S. health care. RESEARCH DESIGN AND METHODS Colorado residents <18 years old who were diagnosed with type 1 diabetes from 2010 to 2017 and subsequently followed at the Barbara Davis Center for Diabetes were included. Logistic regression models were used to test associations among age, sex, race/ethnicity, insurance, language, year of diagnosis, and rural/nonrural residence and DKA at diagnosis. Linear regression models were used to test the association of each predictor with HbA1c at diagnosis. RESULTS There were 2,429 subjects who met the inclusion criteria. From 2010 to 2017, the rate of DKA increased from 41 to 58%. It increased from 35.3 to 59.6% among patients with private insurance (odds ratio 1.10 [95% CI 1.05–1.15]; P < 0.0001) but remained unchanged (52.2–58.8%) among children with public insurance (1.03 [0.97–1.09]; P = 0.36). In the multivariable model, public insurance (1.33 [1.08–1.64]; P = 0.007), rural address (1.42 [1.08–1.86]; P = 0.013), and HbA1c (1.32 [1.26–1.38]; P < 0.0001) were positively associated with DKA, whereas age, race/ethnicity, sex, and primary language were not. CONCLUSIONS The increase in the rate of DKA in patients with newly diagnosed type 1 diabetes was driven by patients with private insurance. This paradoxically occurred during a time of increasing health insurance coverage. More study is needed to understand the factors driving these changes.

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Children with type 1 diabetes often present with the hallmark symptoms of polyuria/polydipsia, and approximately half present with diabetic ketoacidosis (DKA).
“Children with type 1 diabetes often present with the hallmark symptoms of polyuria/polydipsia, and approximately half present with diabetic ketoacidosis (DKA) (30 -32).”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [31]
The Results report that 49% of the 2,429 Colorado children in the study had DKA at type 1 diabetes diagnosis, supporting the 'approximately half' figure for this population. The paper discusses awareness of type 1 diabetes symptoms in the Conclusions but does not identify polyuria or polydipsia or report how often children presented with them. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Children and adolescents often present with DKA as the first manifestation of type 1 diabetes, and rates in the U.S. have increased dramatically over the past 20 years.
“Children and adolescents often present with DKA as the fi rst manifestation of the disease, and rates in the U.S. have increased dramatically over the past 20 years (30 -32).”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [31]
The Results report that DKA was present at diagnosis in many Colorado children and that its prevalence rose from 41.0% to 59.3% between 2010 and 2017. The Introduction also reports an increase in Colorado from 2007 to 2012. These passages support frequent presentation with DKA and a rising rate in Colorado, but not a U.S.-wide increase over 20 years. (LLM, conf=0.88)
Experimental — accuracy not yet measured
People with type 1 diabetes often present with acute symptoms of diabetes and markedly elevated blood glucose levels, and 25-50% are diagnosed with life-threatening DKA.
“People with type 1 diabetes often present with acute symptoms of diabetes and markedly elevated blood glucose levels, and 25 -50% are diagnosed with life-threatening DKA (30 -32).”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [31]
The Results report DKA at diagnosis in 49% of the Colorado children studied, and the Introduction calls DKA life-threatening. The paper does not establish the claimed frequency for people with type 1 diabetes generally, nor does it report that they often present with acute symptoms and markedly elevated blood glucose levels. (LLM, conf=0.88)
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1360-P: Increase in Diabetic Ketoacidosis at Diagnosis of T1D in Colorado Children, 2010-2017
Alonso, G. T., Coakley, A., Pyle, L., Manseau, K., Thomas, S., Rewers, M., & Rewers, A. (2019) · Diabetes · doi:10.2337/db19-1360-p
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Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus
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Increasing Trends in Hospitalisation With Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis Among Children and Youth in the United States and England, 2002–2020
Dave, C. V., Lloyd, K., Nyandege, A. N., Roy, J., López‐Díez, R., Radovick, S., & Strom, B. L. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71279

Authors: Alonso, G. T., Coakley, A., Pyle, L., Manseau, K., Thomas, S., & Rewers, A.
Affiliations: University of Colorado Anschutz (US)
Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
Colorado School of Public Health (US)
Burrell College of Osteopathic Medicine (US)
Corresponding author: Alonso, G. Todd
ORCID: Alonso, G. Todd
Pyle, Laura
Thomas, Sarah
Rewers, Arleta
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2019-10-10
Volume: 43
Issue: 1
Pages: 117-121
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc19-0428
PMC: PMC6925579
OpenAlex: W2979632589
Cited by: 117
References: 23
Citations by year: 2026: 17 · 2025: 13 · 2024: 21 · 2023: 14 · 2022: 13 · 2021: 28 · 2020: 11
FWCI: 10.55
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.diabetesjournals.org/content/license (vor, 71 d)
Locations: Diabetes Care (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
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, pediatric diabetes, newly diagnosed diabetes, health insurance coverage, Affordable Care Act, rural residence, HbA1c, glycemic control, insurance status, Colorado
MeSH terms: Adolescent, Child, Child, Preschool, Colorado, Diabetes Mellitus, Type 1, Ethnicity, Female, Humans, Infant, Infant, Newborn, Male, United States, Diabetic Ketoacidosis

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Diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado children, 2010-2017

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