Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study

Jensen, Elizabeth T.; Stafford, Jeanette M.; Saydah, Sharon; D’Agostino, Ralph B.; Dolan, Lawrence M.; Lawrence, Jean M.; Marcovina, Santica; Mayer-Davis, Elizabeth J.; Pihoker, Catherine; Rewers, Arleta; Dabelea, Dana

doi:10.2337/dc20-0389

Cited by 137Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study

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Jensen, Elizabeth T., Stafford, Jeanette M., Saydah, Sharon, D’Agostino, Ralph B., Dolan, Lawrence M., Lawrence, Jean M., Marcovina, Santica, Mayer-Davis, Elizabeth J. +3 more·2021·Diabetes Care

DOI 10.2337/dc20-0389PMC PMC8323183

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Abstract

OBJECTIVE We previously reported a high (˜30%) but stable prevalence of diabetic ketoacidosis (DKA) at youth-onset diagnosis of type 1 diabetes (2002 and 2010). Given the changing demographics of youth-onset type 1 diabetes, we sought to evaluate temporal trends in the prevalence of DKA at diagnosis of type 1 diabetes from 2010 to 2016 among youth <20 years of age and evaluate whether any change observed was associated with changes in sociodemographic distribution of those recently diagnosed. RESEARCH DESIGN AND METHODS We calculated prevalence of DKA within 1 month of type 1 diabetes diagnosis by year and evaluated trends over time (2010–2016) (n = 7,612 incident diabetes cases; mean [SD] age 10.1 [4.5] at diagnosis). To assess whether trends observed were attributable to the changing distribution of sociodemographic factors among youth with incident type 1 diabetes, we estimated an adjusted relative risk (RR) of DKA in relation to calendar year, adjusting for age, sex, race/ethnicity, income, education, health insurance status, language, season of diagnosis, and SEARCH for Diabetes in Youth Study site. RESULTS DKA prevalence increased from 35.3% (95% CI 32.2, 38.4) in 2010 to 40.6% (95% CI 37.8, 43.4) in 2016 (Ptrend = 0.01). Adjustment for sociodemographic factors did not substantively change the observed trends. We observed a 2% annual increase in prevalence of DKA at or near diagnosis of type 1 diabetes (crude RR 1.02 [95% CI 1.01, 1.04] and adjusted RR 1.02 [95% CI 1.01, 1.04]; P = 0.01 for both). CONCLUSIONS Prevalence of DKA at or near type 1 diabetes diagnosis has increased from 2010 to 2016, following the high but stable prevalence observed from 2002 to 2010. This increase does not seem to be attributable to the changes in distribution of sociodemographic factors over time.

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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 [32]
The Results report that DKA was common at or near diagnosis, but occurred in 38.5% of the youth studied, rather than approximately half; the figure was 46.7% only among those aged 0–4. The Introduction mentions diabetes symptoms generally, but the passages found do not identify polyuria or polydipsia as common presenting symptoms. (LLM, conf=0.88)
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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 [32]
The Introduction says DKA commonly occurs at diabetes diagnosis, supporting the first part of the claim. The Results report an increase from 35.3% in 2010 to 40.6% in 2016, while the Conclusions describe prevalence from 2002 to 2010 as high but stable. The paper therefore supports an increase, but not a dramatic increase over the past 20 years. (LLM, conf=0.90)
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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 [32]
The Results report DKA at or near diagnosis in 38.5% of youth with type 1 diabetes, within the claimed 25–50% range. The Introduction calls DKA potentially life-threatening and describes hyperglycemia at its onset. The study concerns youth, however, and these passages do not establish that people with type 1 diabetes generally often present with acute symptoms and markedly elevated blood glucose. (LLM, conf=0.85)
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Authors: Jensen, E. T., Stafford, J. M., Saydah, S., D’Agostino, R. B., Dolan, L. M., Lawrence, J. M., Marcovina, S., Mayer-Davis, E. J., Pihoker, C., Rewers, A., & Dabelea, D.
Affiliations: Wake Forest University Health Sciences (US)
Centers for Disease Control and Prevention (US)
University of Cincinnati (US)
Kaiser Permanente (US)
University of Washington (US)
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
University of Colorado Denver (US)
Colorado School of Public Health (US)
Corresponding author: Jensen, Elizabeth T.
ORCID: Jensen, Elizabeth T.
Stafford, Jeanette M.
Saydah, Sharon
Dolan, Lawrence M.
Lawrence, Jean M.
Marcovina, Santica
Mayer-Davis, Elizabeth J.
Pihoker, Catherine
Rewers, Arleta
Dabelea, Dana
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2021-07-01
Volume: 44
Issue: 7
Pages: 1573-1578
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc20-0389
PMC: PMC8323183
OpenAlex: W3170862402
Cited by: 137
References: 37
Citations by year: 2026: 26 · 2025: 35 · 2024: 25 · 2023: 18 · 2022: 18 · 2021: 15
FWCI: 14.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.diabetesjournals.org/content/license (vor)
Locations: Diabetes Care (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Kaiser Permanente (UL1 TR000077, 200-2010-35171, U01 DP000244, U18DP002710-01, U01 DP000248, UL1 TR00423, U18DP002708, 1U18DP002709, U01 DP000246, U48/CCU419249, UL1 TR000062, U18DP006134, DP000254, U18DP006136, U01 DP000247, U48/CCU819241-3, UL1 TR000154, P30 DK57516, U48/CCU919219, U18DP002714, U18DP006139, U18DP006138, 1UC4DK108173, U18DP006133, UL1 TR001425, U58/CCU019235-4, U18DP002710, U18DP000247-06A1, U01 DP000250, U01 DP000254)
Medical University of South Carolina (TR001450, UL1TR001450, UL1TR000062)
Wake Forest University (U18DP002714, U18DP002710, U58/CCU019235-4, 200-2010-35171, UL1 TR000077, U18DP006138, U18DP000247-06A1, U18DP006139, U18DP002708, UL1 TR000154, UL1 TR001425, U18DP002710-01, U48/CCU819241-3, U01 DP000247, U18DP006133, UL1 TR00423, 1U18DP002709, P30 DK57516, U48/CCU419249, UL1 TR000062, U18DP006131, U01 DP000246, U18DP006136, DP000254, U48/CCU919219, 1UC4DK108173, U01 DP000244, U01 DP000248, U18DP006134, U01 DP000250, U01 DP000254)
University of Washington (UL1 TR00423)
University of Cincinnati (UL1 TR000077, UL1 TR001425)
University of South Carolina (UL1 TR000062)
Seattle Children's Research Institute
Ohio Department of Health (U48/CCU919219, UL1 TR001425, U18DP006136, U01 DP000246, U58/CCU019235-4, U48/CCU419249, U18DP006134, U18DP000247-06A1, UL1 TR000062, U18DP002708, U18DP002710-01, 200-2010-35171, U18DP006139, UL1 TR000154, 1U18DP002709, UL1 TR000077, 1UC4DK108173, UL1 TR00423, P30 DK57516, U01 DP000254, U01 DP000248, U18DP006138, U01 DP000250, U01 DP000247, U18DP006133, U18DP002714, U01 DP000244)
National Institutes of Health (UL1TR000154, U18DP002708, U18DP006138, U48/CCU419249, UL1TR000423, U18DP006136, UL1TR000062, U58/CCU019235-4, U48/CCU919219, U18DP006139, U18DP006133, U01 DP000250, UL1TR001425, U01 DP000247, U18DP002710, U18DP002714, U01 DP000246, U01 DP000244, 1U18DP002709, U48/CCU819241-3, U18DP000247-06A1, 200-2010-35171, DP000254, U18DP002710-01, U01 DP000254, U01 DP000248, UL1TR001450, U18DP006134, UL1TR000077, TR000077, TR000062, DK57516, TR001425, TR000154)
Centers for Disease Control and Prevention (UL1 TR00423, U18DP002714, 200-2010-35 171, U01DP000244, U01DP000250, U18DP000247‐06A1, U18DP006138, U18DP006134, U18DP002710, U48/CCU419249, U18DP006136, U58/CCU019235-4, UL1 TR000062, UL1 TR001425, U18DP006139, U18DP002708, U01DP000247, U01DP000248, U18DP002710‐01, DP000254, P30 DK57516, U01DP000254, U01DP000246, UL1 TR000154, U48/CCU919219, U18DP006133, UL1 TR000077, U48/CCU819241‐3, 1UC4DK108173, 1U18DP002709)
University of North Carolina at Chapel Hill (U01 DP000248, U18DP002714, UL1 TR001425, DP000254, U01 DP000250, U18DP000247-06A1, UL1 TR000077, U48/CCU419249, 200-2010-35171, U01 DP000247, U18DP002710, U18DP006133, U18DP006136, U18DP006134, U48/CCU919219, UL1 TR000062, U48/CCU819241‐3, U58/CCU019235-4, 1U18DP002709, U01 DP000254, U01 DP000246, U01 DP000244, 1UC4DK108173, P30 DK57516, U18DP006139, U18DP002708, UL1 TR00423, U18DP006138, UL1 TR000154, U18DP002710-01)
University of Colorado Denver (U18DP002714, U01 DP000244, 200-2010-35171, U48/CCU819241-3, U18DP006134, U01 DP000254, U18DP006136, U18DP006133, DP000254, UL1 TR000077, 1U18DP002709, U18DP000247-06A1, U01 DP000246, U01 DP000248, U18DP002708, 1UC4DK108173, U18DP006139, U01 DP000250, UL1 TR000154, U48/CCU419249, U18DP006138, P30 DK57516, U01 DP000247, UL1 TR00423, U18DP002710, UL1 TR000062, U48/CCU919219, U18DP002710-01, U58/CCU019235-4, UL1 TR001425)
National Institute of Diabetes and Digestive and Kidney Diseases (U18DP006133, 200-2010-35171, U01 DP000250, U18-DP-002714, U01-DP-000247, P30DK057516, 1U18-DP-002709, U01 DP000248, U01 DP000254, U48/CCU919219, U18DP006139, U18DP006131, U48/CCU419249, U01 DP000254, and U18DP002708, UC4DK108173, U18-DP-002708, U48/CCU919219, U01 DP000250, and 200-2010-35171, U01 DP000244, U58/CCU019235-4, U18-DP-000247-06A1, R01DK127208, U48/CCU819241-3, U18DP002710-01, U18DP006136, U18DP006138, U18DP006134, U58/CCU019235-4, U01 DP000244, and U18DP002710-01, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1, U01-DP-000246, U18DP002710, DP000254, U48/CCU419249)
National Center for Chronic Disease Prevention and Health Promotion (U01 DP-000247, U18 DP-002709, U18 DP006134, U18-DP-002708, U01-DP000246, U01-DP-000250, U01-DP-000254, U18 DP002714, U18 DP006139, U01 DP000248, U18 DP006138, U18 DP006136, U18 DP006131, U18 DP006133, U01DP000244, U18 DP002710)
National Center for Advancing Translational Sciences (TR001450, U18DP000247-06A1, U01 DP000244, U58/CCU019235-4, U01 DP000248, U18DP002708, U18DP002714, U48/CCU919219, U01 DP000246, 200-2010-35171, U01 DP000254, U48/CCU419249, U01 DP000250, U18DP006134, U18DP006136, U18DP002710-01, 1U18DP002709, U18DP006138, UL1 TR000062 and UL1 TR001450, U01 DP000247, U18DP006139, U18DP006133)
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, youth-onset diabetes, prevalence trends, SEARCH for Diabetes in Youth, sociodemographic factors, diabetes diagnosis, temporal trends
MeSH terms: Adolescent, Child, Diabetes Mellitus, Type 1, Ethnicity, Humans, Prevalence, Diabetic Ketoacidosis

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Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study

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