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Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic

Charlotte E M Rugg-Gunn1, Eleanor Dixon2, Andrea L Jorgensen3

  • 1University of Liverpool Medical School, Liverpool, England.

JAMA Pediatrics
|October 10, 2022
PubMed

Insights

Diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) onset is a risk for children. Younger age, minority ethnicity, and delayed diagnosis increase DKA risk, while family history and screening decrease it.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Public Health

Background:

  • Diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) is a significant risk in pediatric populations.
  • Previous systematic reviews highlighted key risk factors, necessitating an updated analysis due to new research.

Approach:

  • A comprehensive systematic review was conducted, searching multiple databases (PubMed, Embase, Scopus, etc.) for studies published between January 2011 and November 2021.
  • Data from 195 studies (including 46 from a prior review) were pooled using a random-effects model to identify factors associated with DKA at T1D onset in individuals under 18.

Key Points:

  • Factors associated with increased DKA risk include younger age (<2 years), minority ethnicity, and delayed diagnosis.
  • Presentation during the COVID-19 pandemic emerged as a new risk factor.
  • Protective factors identified were family history of T1D and participation in screening programs.

Conclusions:

  • Younger age, minority status, delayed diagnosis, and the COVID-19 pandemic are linked to higher DKA risk at T1D onset.
  • Increased awareness of T1D symptoms and participation in screening can mitigate DKA risk.
  • Future strategies should target these identified factors to reduce DKA incidence in new T1D cases.
Abstract

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