234-LB: Incidence Trends of Diabetic Ketoacidosis at and after Diagnosis of Type 1 Diabetes in British Columbia, Canada

Objective: Diabetic ketoacidosis (DKA) is a preventable complication in youth with type 1 diabetes (T1D). This study aimed to estimate the incidence trend of DKA at T1D diagnosis (DKA-AT, defined as DKA within 14 days of T1D diagnosis) and after T1D diagnosis (DKA-AFTER, defined as DKA after 14 days of T1D diagnosis) from 2002 to 2012 in British Columbia, Canada.

Methods: We used a previously described population-based cohort of individuals diagnosed with T1D at <20 years of age. DKA episodes were identified using ICD9/10 codes (250.1X/E101X). Incidence rate ratio (IRR) was estimated using Poisson regression and trends in DKA rates were examined using Joinpoint regression analyses.

Results: 2615 incident cases of T1D were identified between 2002 and 2012, of which 847 (32.4%) were diagnosed with DKA-AT. 52% were male. The rates of DKA-AT by year ranged between 24.1% (2008) and 37.3% (2006). No sex differences were observed. The IRR was 2.0 (95% CI: 1.6, 2.5; p<0.001) for those diagnosed with T1D at 0-4 years compared to those diagnosed at 15-19 years old, after adjusting for the trend by fiscal year. In the same period, 1886 episodes of DKA-AFTER were identified with a consistent increase from 5.3% (2002) to 9.5% (2012). The IRR for DKA-AFTER in children 0-4 years old at diabetes diagnosis was 9.13 (95% CI: 7.73, 10.77; p<0.001). After adjusting for the increasing trend by fiscal year, females had higher rates of DKA-AFTER than males (IRR 1.45, 95% CI: 1.33, 1.59; p<0.001). The average annual percent change for DKA-AFTER was 4.91% (95% CI: 2.69, 7.18; p<0.001).

Conclusions: DKA-AT incidence remained unchanged while the incidence of DKA-AFTER increased over time, with the greatest burden in those diagnosed at a younger age. Targeted interventions are needed to raise public awareness to prevent DKA-AT and to educate patients and families in preventing DKA-AFTER.