SAN DIEGO — One-fourth of children with diabetes present with ketoacidosis at onset, and a majority are hospitalized, Arleta B. Rewers, M.D., reported at the annual scientific sessions of the American Diabetes Association.
Younger and poorer children are more likely to present with diabetic ketoacidosis (DKA), according to a study of 824 children and adolescents younger than 20 years of age who were diagnosed with diabetes in 2002 in four U.S. geographical areas and two large HMOs, said Dr. Rewers, an emergency physician at the Children's Hospital, Denver.
Of the 824 children with new-onset diabetes, 57% were hospitalized while just 12% had an emergency department visit only. Diabetic ketoacidosis, defined as a bicarbonate level of less than 15 mmol/L and/or a pH less than 7.25 (or less than 7.3 if arterial or capillary blood was obtained), was present in 24%. No significant differences in DKA rates by gender or race/ethnicity were found, Dr. Rewers reported.
The proportion presenting with DKA decreased significantly with increasing age, from 36% of children aged 0–4 years down to 16.5% of adolescents aged 15–19 years. Among those diagnosed as having type 1 diabetes, the prevalence of DKA was 28%, more than double the prevalence in children diagnosed with type 2 diabetes (13%) or an unknown type (12%).
Lower parental income and lower parental educational achievement were significantly associated with an increased likelihood of the child presenting with DKA.
After adjustment for clinic, gender, race/ethnicity, diabetes type, and insurance coverage, children aged 0–4 years were 5.6 times more likely than older children to present with DKA, while those with annual family incomes less than $55,000 had a risk for DKA that was five times greater than that of children whose parents made between $75,000 and $100,000 a year, she said.
Source: Dr. Yusuf