A systematic review and meta-analysis by a UK research team provides physicians with an overview of factors associated with an increased and decreased risk of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in pediatric patients.
The results of the study, which included data from 195 published papers involving more than 185,000 pediatric patients from 47 countries, suggest that multiple factors, including younger age and being from a minority ethnic group, were associated with an increased risk while A family history of type 1 diabetes and higher parental education were associated with a reduced risk of presenting with DKA at the onset of type 1 diabetes.
“This systematic review provides up-to-date data on the association between risk factors and the presence of DKA at the onset of T1D. The results showed that people at greatest risk of DKA included young children, people with late or missing diagnoses, people belonging to ethnic minorities, and people presenting during the COVID-19 pandemic,” the investigators wrote.
Among the most common diabetes-related emergencies for people with type 1 diabetes, DKA represents one of the most common threats to the overall well-being of people with pediatric type 1 diabetes. Intending to build on data from a systematic review published in 2011, the current research project was led by Daniel B. Hawcutt, MBChB, MD, from the University of Liverpool and a team of colleagues from several institutions in the UK.
In the 2011 systematic review, which included 46 studies involving more than 24,000 children in 31 countries, the results pointed to young age, diagnostic error, and belonging to a minority ethnic group as key factors related to DKA at the initial presentation of T1D. 1 In the current study, researchers hoped to provide an update on the results of the 2011 systematic review by conducting their own systematic review and meta-analysis.
With this in mind, researchers conducted a search of PubMed, Embase, Scopus, CINAHL, and Web of Science and generated article reference lists using the population, intervention, comparative, and outcome search strategy for studies of DKA and the occurrence of type 1 -Diabetes screens people under 18 years of age published from January 2011 to November 2021. A random effects model was used to estimate associations between factors of interest and DKA in the onset of type 1 diabetes, using data from this study in combination with Data from the 2011 nomenclature were used for review.
In their search, the researchers identified 149 articles with data from 188,637 pediatric patients from 47 different countries for inclusion. Together with the published papers included in the 2011 systematic review, the investigators’ systematic review included 195 studies. From these studies, 38 factors were identified for inclusion in the investigators’ analyses.
Upon analysis, results indicated younger age at onset (less than 2 years vs. 2 or more years; odds ratio [OR]3.51 [95% CI, 2.85-4.32]; P<.001) and belonging to an ethnic minority (OR, 0.40 [95% CI, 0.21-0.74]; P= 0.004) were associated with an increased risk of DKA in onset of type 1 diabetes, which the researchers said was consistent with the 2011 systematic review. Investigators pointed to a delayed diagnosis (OR, 2.27 [95% CI, 1.72-3.01]; P< .001) and presentation during the COVID-19 pandemic (OR, 32.2 [95% CI, 1.76-3.06]; P<0.001) were identified as factors associated with an increased risk of DKA in onset of type 1 diabetes in the present analyzes but not in the 2011 systematic review. The results revealed a family history of type 1 diabetes (OR, 0.46 [95% CI, 0.37-0.57]; P< 0.001) and participation in screening programs (OR, 0.35 [95% CI, 0.21-0.59]; P< 0.001) were associated with a reduced risk of DKA in type 1 diabetes at the time of diagnosis.
“A strategy to achieve reduced DKA may include screening the national population to identify those at greatest risk. However, given the potential for significant psychological and economic distress, the merits of this strategy should be carefully evaluated,” the investigators added. “In addition, some awareness campaigns, while shown to be associated with reduced DKA incidence, should be targeted appropriately to have the greatest impact.”
This study “Factors Associated With Diabetic Ketoacidose at Onset of Type 1 Diabetes Among Pediatric Patients” was published in JAMA Pediatrics.