Portal de Periódicos da CAPES

Trends in the Prevalence of Ketoacidosis at Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study

2014; American Academy of Pediatrics; Volume: 133; Issue: 4 Linguagem: Inglês

10.1542/peds.2013-2795

1098-4275

Dana Dabelea, Arleta Rewers, Jeanette M. Stafford, Debra A. Standiford, Jean M. Lawrence, Sharon Saydah, Giuseppina Imperatore, Ralph B. D’Agostino, Elizabeth J. Mayer‐Davis, Catherine Pihoker,

Cardiovascular Function and Risk Factors

To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence.Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002-2003, 2004-2005, and 2008-2010). Logistic regression was used to determine factors associated with DKA.In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002-2003, 29.1% in 2004-2005, and 31.1% in 2008-2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002-2003 to 5.7% in 2008-2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001).The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time.