Diagnosis of Diabetic Ketoacidosis, Type 1 Diabetes Results in Poor Disease Control

Children diagnosed with diabetic ketoacidosis and type 1 diabetes may have higher HbA1C levels.

Findings from a new study published by Diabetes Care suggests that pediatric patients who are diagnosed with diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis may have an increased risk of poor disease control.

Included in the study were 3364 children living in Colorado who were diagnosed with type 1 diabetes between 1998 and 2012. At baseline, 39% (1297) patients had DKA at diagnosis of type 1 diabetes.

The authors found that ethnicity and health insurance status were linked to presenting DKA at diagnosis. Additionally, they discovered that these patients had higher HbA1C levels over a 15-year follow-up period, according to the study.

After accounting for age, ethnicity, family history of diabetes, insurance status, and insulin pump use, 40% of patients with a dual diagnosis had poor blood glucose control.

Compared with children without DKA, HbA1c was 1.4% higher among patients with severe DKA and 0.9% higher among patients presenting mild or moderate DKA at diagnosis, according to the study.

The authors concluded that worsening of beta cell death that results from hyperglycemia and inflammation related to DKA may worsen blood glucose control, according to the study. They also noted that DKA can have an effect on cognitive function, which may be a factor in decreased self-care.

"I think people do not realize the long-term implications of DKA. We've shown it persists for at least 15 years," study co-author Arleta Rewers, MD, told Medscape Medical News. “This is how long we had data, but I'm pretty sure the effect lasts even beyond 15 years.”

These results highlight the need to recognize the signs and symptoms of type 1 diabetes and immediately begin treatment with insulin to prevent DKA, according to the authors. Many pediatric patients are not screened for diabetes due to symptoms that can be mistaken for another condition.

The authors also suggest that these results provide support for the push towards universal pediatric autoantibody screening for type 1 diabetes for early diagnosis, according to the study.

"DKA at diagnosis of type 1 diabetes is not just an acute complication but is also a harbinger of increased morbidity and mortality associated with poor glycemic control,” the authors concluded. "Consequently, effective prevention of DKA at diagnosis may provide enduring benefits. Future studies are warranted to assess the effectiveness of DKA prevention at type 1 diabetes onset on improving long-term glycemic control."