Burden of diabetic ketoacidosis still unacceptably high

Diabetic ketoacidosis (DKA), a life-threatening but preventable condition, remains an important problem for youth with diabetes and their families. Diabetic ketoacidosis is due to a severe lack of insulin and it is often the presenting symptom of type 1 diabetes. It can also be present at the onset of type 2 diabetes.

SEARCH for Diabetes in Youth, a multi-center, multiethnic study of childhood diabetes, is the largest surveillance effort of diabetes among youth under the age of 20 conducted in the United States to date. The study covers 5 locations across the country where about 5.5 million children live.

In a report in the April, 2014, issue of the Pediatrics, study investigators analyzed data from 5615 youth with type 1 and 1425 youth with type 2 diabetes newly diagnosed between 2002 and 2010. The study, led by Dana Dabelea, MD, PhD, professor and associate dean at the University of Colorado School of Public Health, shows that the frequency of DKA at diagnosis in U.S. youth with type 1 diabetes did not decline over the last 8 years, but remained high compared with other developed countries, with almost a third of all youth with type 1 diabetes presenting in DKA.

Rates were disproportionately high in children younger than 5 years of age, non-White racial/ethnic groups, youth without private health insurance and those with lower family income. Among youth with type 2 diabetes, DKA was much less common and decreased over time, suggesting improved detection or earlier diagnosis of diabetes.

Dabelea says “These data suggest that more needs to be done to begin reducing DKA rates in the future. Previous research suggests that increased community awareness of type 1 diabetes, including parental education and closer monitoring of signs and symptoms of diabetes, may be effective tools. In the U.S., improved health care access especially for underserved populations is also needed to reduce the observed health disparities.”

SEARCH has estimated that there were at least 188,811 youth with diabetes in the U.S. in 2009: 168,141 with type 1 diabetes and 19,147 with type 2 diabetes. In the U.S. and worldwide, the incidence of type 1 diabetes in youth has been increasing by 3% to 4% per year, with limited estimates for type 2 diabetes except in minority populations in whom increased prevalence has also been reported.

The SEARCH study was funded by the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the National Institutes of Health (NIH). It involves five research sites in the states of California (Jean M. Lawrence, ScD, principal investigator for Kaiser Permanente Southern California), Colorado (Dana Dabelea, MD, study co-chair and principal investigator at University of Colorado Denver), Ohio (Lawrence Dolan, MD, principal investigator for Cincinnati Children's Hospital), South Carolina (Elizabeth Mayer-Davis, PhD, study co-chair and principal investigator at University of North Carolina Chapel Hill) and Washington (Catherine Pihoker, MD, principal investigator for Seattle Children's Hospital). The central laboratory for the study is the Northwest Lipid Research Laboratories in Seattle, Washington (Santica Marcovina, PhD, principal investigator). The coordinating center is at the Division of Public Health Sciences at Wake Forest School of Medicine (Ronny Bell, PhD, principal investigator and Ralph B. D`Agostino Jr, co-principal investigator).

About the Colorado School of Public Health

The Colorado School of Public Health is the first and only accredited school of public health in the Rocky Mountain Region, attracting top tier faculty and students from across the country, and providing a vital contribution towards ensuring our region's health and well-being. Collaboratively formed by the University of Colorado Denver, Colorado State University, and the University of Northern Colorado, the Colorado School of Public Health provides training, innovative research and community service to actively address public health issues, including chronic disease, access to health care, environmental threats, emerging infectious diseases, and costly injuries.