Recurrent DKA is associated with increased mortality in children; however, data is limited in adults. We compared clinical characteristics and outcomes of adults (≥ 18 years) and children (< 18 years) at enrollment with history of recurrent DKA (≥ 1 episode) within the T1D Exchange clinic registry (n=33,902). DKA episodes were self-reported as those experienced 12 months prior to enrollment and before each study visit.
We identified 1758 people with recurrent DKA after diagnosis (Table). Median follow-up was 3.6 years. Adults with recurrent DKA had more islet cell or pancreatic transplant, less insurance and higher mortality compared to children, but less DKA at diagnosis. In both children and adults, mortality was higher with age (children: OR 1.24, 95% CI 1.02,1.50; adults: OR 1.09, 95% CI 1.06, 1.11) and no insurance (children: OR 3.83, 95% CI 1.32, 11.09; adults: OR 2.29, 95% CI 1.12, 4.69). Children with recurrent DKA had higher mortality (OR: 4.21, 95% CI 1.28, 13.86) compared to adults (OR: 2.36, 95% CI 0.53, 10.46). DKA at diagnosis of T1D was associated with higher mortality in adults (OR: 2.97, 95% CI 1.44, 6.11) but not in children (OR: 1.40, 95% CI 0.49, 3.97).
Adults and children with recurrent DKA have poor control but differ in socioeconomic factors and presentation of T1D. Even though adults present less with DKA at diagnosis, presentation with DKA is associated with higher mortality.
| Children (n=1193) | Adults (n=565) | p-value | |
| Age, years | 12.3 ± 3.9 | 31.9 ± 14.8 | <0.001 |
| Duration of DM, years | 5.2 ± 3.6 | 15.7 ± 11.6 | <0.001 |
| BMI, kg/m2 | 21.5± 4.9 | 25.2 ± 4.9 | <0.001 |
| HbA1c (%) | 9.6 ± 1.9 | 9.8 ± 2.3 | 0.55 |
| Female, n (%) | 628 (55) | 316 (59) | 0.17 |
| Race, White n (%) | 773 (65) | 371 (66) | 0.47 |
| Pump Use, n (%) | 457(38) | 244(43) | 0.13 |
| Islet cell or pancreatic transplant, n (%) | 0 (0) | 10 (9.1) | <0.001 |
| No Insurance, n (%) | 6 (0.8) | 26 (7.6) | <0.001 |
| DKA at diagnosis, n (%) | 577 (59) | 135 (46) | <0.001 |
| Death, any cause, n (%) | 6 (0.5) | 9 (1.6) | 0.025 |
| Data are presented as mean ± SD unless noted otherwise | |||
| Children (n=1193) | Adults (n=565) | p-value | |
| Age, years | 12.3 ± 3.9 | 31.9 ± 14.8 | <0.001 |
| Duration of DM, years | 5.2 ± 3.6 | 15.7 ± 11.6 | <0.001 |
| BMI, kg/m2 | 21.5± 4.9 | 25.2 ± 4.9 | <0.001 |
| HbA1c (%) | 9.6 ± 1.9 | 9.8 ± 2.3 | 0.55 |
| Female, n (%) | 628 (55) | 316 (59) | 0.17 |
| Race, White n (%) | 773 (65) | 371 (66) | 0.47 |
| Pump Use, n (%) | 457(38) | 244(43) | 0.13 |
| Islet cell or pancreatic transplant, n (%) | 0 (0) | 10 (9.1) | <0.001 |
| No Insurance, n (%) | 6 (0.8) | 26 (7.6) | <0.001 |
| DKA at diagnosis, n (%) | 577 (59) | 135 (46) | <0.001 |
| Death, any cause, n (%) | 6 (0.5) | 9 (1.6) | 0.025 |
| Data are presented as mean ± SD unless noted otherwise | |||
P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. L. Peng: None. N. Dhruv: None. C. Ramos: None. J. Haw: None. R.J. Galindo: None. G. Davis: None. M. Fayfman: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
