Predictors of diabetic ketoacidosis in children and adolescents with type 1 diabetes. Experience from a large multicentre database

Objective: Diabetic ketoacidosis (DKA) remains a major cause of hospitalization and death in children and adolescents with established type 1 diabetes despite DKA preventing strategies. The aim of the study was to determine incidence and risk factors for DKA in a large cohort of young diabetic patients. Methods: This investigation uses the dpv-wiss base containing data on 28 770 patients with type 1 diabetes < 20yr, from Germany and Austria. For each patient the most recent year of follow-up was evaluated. DKA was defined as pH < 7.3 and/or hospital admission as a result of DKA, excluding onset DKA. Results: Mean age of the study cohort was 13.96 +/- 4.0 yr (47.9% females). A total of 94.1% presented with no episode, 4.9% with 1 episode, and 1.0% with recurrent DKA (>= 2). When comparing these three groups, age (p < 0.01), HbA1c (p < 0.01), and insulin dose (p < 0.01) were significantly higher in patients with recurre nt DKA. Incidence of DKA was significantly higher in females (7.3 +/- 0.5 vs. 5.8 +/- 0.2; p = 0.03) and in patients with migration background (7.8 +/- 0.6 vs. 6.3 +/- 0.3; p = 0.02). No significant association was found with treatment type and diabetes duration. Conclusion: In a cohort of European paediatric diabetic patients, the rate of DKA was significantly higher in females and in children with migration background and early teenage years.