OBJECTIVE: This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SD score (SDS), and diabetes technology uptake in youth. RESEARCH DESIGN AND METHODS: Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. RESULTS: The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). CONCLUSIONS: Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

Barbara Davis Center University of Colorado Anschutz Medical Campus Aurora CO

Department of Endocrinology Diabetes and Metabolism University Children's Hospital University Medical Centre Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Department of Pediatric Diabetes and Endocrinology Centre Hospitalier Luxembourg Luxembourg Luxembourg

Department of Pediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Department of Pediatrics and Adolescent Medicine Medical University Graz Graz Austria

Department of Pediatrics Faculty of Medicine and University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

Department of Pediatrics University of Otago Christchurch New Zealand

Department of Women's and Children's Health Salesi Hospital Ancona Italy

Faculty of Science Technology and Medicine University of Luxembourg Esch Belval Luxembourg

Institute of Epidemiology and Medical Biometry Munich Neuherberg Germany

Paediatric Endocrinology and Diabetology University Children's Hospital Julie von Jenner Haus University of Bern Bern Switzerland

Zobrazit více v PubMed

Phillip M, Achenbach P, Addala A, et al. . Consensus guidance for monitoring individuals with islet autoantibody–positive pre-stage 3 type 1 diabetes. Diabetes Care 2024;47:1276–1298 PubMed PMC

Birkebaek NH, Kamrath C, Grimsmann JM, et al. . Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries. Lancet Diabetes Endocrinol 2022;10:786–794 PubMed PMC

Wentworth JM, Oakey H, Craig ME, et al. . Decreased occurrence of ketoacidosis and preservation of beta cell function in relatives screened and monitored for type 1 diabetes in Australia and New Zealand. Pediatr Diabetes 2022;23:1594–1601 PubMed PMC

Marcovecchio ML, Hendriks AEJ, Delfin C, et al. ; INNODIA consortium . The INNODIA type 1 diabetes natural history study: a European cohort of newly diagnosed children, adolescents and adults. Diabetologia 2024;67:995–1008 PubMed PMC

Hammersen J, Tittel SR, Warncke K, et al. ; DPV Initiative . Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: results from the DPV initiative. Pediatr Diabetes 2021;22:455–462 PubMed

Ghetti S, Kuppermann N, Rewers A, et al. ; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group . Cognitive function following diabetic ketoacidosis in children with new-onset or previously diagnosed type 1 diabetes. Diabetes Care 2020;43:2768–2775 PubMed PMC

Hammersen J, Tittel SR, Kamrath C, et al. . Clinical outcomes in pediatric patients with type 1 diabetes with early versus late diagnosis: analysis from the DPV registry. Diabetes Care 2024;47:1808–1817 PubMed

Duca LM, Wang B, Rewers M, Rewers A.. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 2017;40:1249–1255 PubMed

Sherr JL, Schoelwer M, Dos Santos TJ, et al. . ISPAD Clinical Practice Consensus Guidelines 2022: diabetes technologies: insulin delivery. Pediatr Diabetes 2022;23:1406–1431 PubMed

Lakshman R, Najami M, Allen JM, et al. . Diabetic ketoacidosis at onset of type 1 diabetes and glycemic outcomes with closed-loop insulin delivery. Diabetes Technol Ther 2024;26:198–202 PubMed PMC

Zaharieva DP, Ding VY, Addala A, et al. . Diabetic ketoacidosis at diagnosis in youth with type 1 diabetes is associated with a higher hemoglobin A1c even with intensive insulin management. Diabetes Technol Ther 2024;26:176–183 PubMed PMC

American Diabetes Association Professional Practice Committee . 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Suppl. 1):S20–S42 PubMed PMC

World Health Organization. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Accessed 3 November 2021. Available from https://www.who.int/publications/i/item/924154693X

Glaser N, Fritsch M, Priyambada L, et al. . ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022;23:835–856 PubMed

de Onis M, WHO Multicentre Growth Reference Study Group . WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr 2006;95:76–85 PubMed

Cole TJ, Green PJ.. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11:1305–1319 PubMed

Rugg-Gunn CEM, Dixon E, Jorgensen AL, et al. . Factors associated with diabetic ketoacidosis at onset of type 1 diabetes among pediatric patients: a systematic review. JAMA Pediatr 2022;176:1248–1259 PubMed

Perkins BA, Bebu I, de Boer IH, et al. ; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group . Risk factors for kidney disease in type 1 diabetes. Diabetes Care 2019;42:883–890 PubMed PMC

Miller RG, Orchard TJ, Costacou T.. 30-year cardiovascular disease in type 1 diabetes: risk and risk factors differ by long-term patterns of glycemic control. Diabetes Care 2022;45:142–150 PubMed PMC

Reiss AL, Jo B, Arbelaez AM, et al. ; Diabetes Research in Children Network (DirecNet) Consortium . A pilot randomized trial to examine effects of a hybrid closed-loop insulin delivery system on neurodevelopmental and cognitive outcomes in adolescents with type 1 diabetes. Nat Commun 2022;13:4940. PubMed PMC

Phillip M, Nimri R, Bergenstal RM, et al. . Consensus recommendations for the use of automated insulin delivery technologies in clinical practice. Endocr Rev 2023;44:254–280 PubMed PMC

Prahalad P, Scheinker D, Desai M, et al. . Equitable implementation of a precision digital health program for glucose management in individuals with newly diagnosed type 1 diabetes. Nat Med 2024;30:2067–2075 PubMed PMC

Mortensen HB, Swift PGF, Holl RW, et al. ; Hvidoere Study Group on Childhood Diabetes . Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis. Pediatr Diabetes 2010;11:218–226 PubMed

Pollé OG, Delfosse A, Martin M, et al. ; DIATAG Working Group . Glycemic variability patterns strongly correlate with partial remission status in children with newly diagnosed type 1 diabetes. Diabetes Care 2022;45:2360–2368 PubMed PMC

Fureman A-L, Bladh M, Carlsson A, et al. . Partial clinical remission of type 1 diabetes in Swedish children: a longitudinal study from the Swedish National Quality Register (SWEDIABKIDS) and the Better Diabetes Diagnosis (BDD) study. Diabetes Technol Ther 2024;26:851–861 PubMed

Fuhri Snethlage CM, McDonald TJ, Oram RD, et al. . Residual β-cell function is associated with longer time in range in individuals with type 1 diabetes. Diabetes Care 2024;47:1114–1121 PubMed PMC

Auzanneau M, Rosenbauer J, Warncke K, et al. . Frequency of ketoacidosis at diagnosis of pediatric type 1 diabetes associated with socioeconomic deprivation and urbanization: results from the German Multicenter DPV Registry. Diabetes Care 2022;45:1807–1813 PubMed

O’Reilly JE, Jeyam A, Caparrotta TM, et al. ; Scottish Diabetes Research Network Epidemiology Group . Rising rates and widening socioeconomic disparities in diabetic ketoacidosis in type 1 diabetes in Scotland: a nationwide retrospective cohort observational study. Diabetes Care 2021;44:2010–2017 PubMed

Alonso GT, Reinauer C, Williams GM, et al. . Regional deprivation and diabetic ketoacidosis at type 1 diabetes diagnosis in children and adolescents: international comparison among 6 countries. Horm Res Paediatr. 12 December 2024. [Epub ahead of print] PubMed

Ghetti S, Kuppermann N, Rewers A, et al. . Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes. Endocrinol Diabetes Metab 2023;6:e412. PubMed PMC

de Bock M, Codner E, Craig ME, et al. . ISPAD Clinical Practice Consensus Guidelines 2022: glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes 2022;23:1270–1276 PubMed PMC