Visual Abstract
Aim: Diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) are preventable, life-threatening complications of T1D, associated with morbidity, mortality, and healthcare costs. We examined incidence rates (IR) and risk factors for DKA and SH in a contemporary cohort of teens with T1D followed prospectively at 2 US pediatric diabetes centers.
Methods: Data were collected by EHR review and parent-youth interview quarterly for 18 months in 301 adolescents, aged 13-17 at baseline, with T1D for 6+ months, and a wide range of A1c (6.5-<13%). Outcomes were IR of DKA leading to ER visit or hospitalization and SH with altered consciousness and/or needing assistance (enteral or parenteral) for recovery.
Results: The sample (50% male, 22% non-white) had a mean±SD age 15.0±1.3 years, T1D duration 6.5±3.7 years, and A1c 8.5±1.1%; 59% pump-treated. DKA IR was 9.3/100 person-years; SH IR was 42.6/100 person-years. Many diabetes management factors were associated with higher IR of DKA and SH (Figure). Non-modifiable demographic and family factors associated with DKA and SH included non-white ethnicity, lower parent education, public insurance, and lower household income (p<.0001-<.05).
Summary: IR of DKA and SH remain high in teens with T1D. Recognized modifiable (glucose monitoring [possibly by CGM] and A1c) and non-modifiable socio-demographic factors can be targeted to reduce rates of acute complications.
M. D. Ivanova: None. L. K. Volkening: None. B. Anderson: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc.
National Institutes of Health (R01DK095273, P30DK036836); JDRF (2-SRA-2014-253-M-B)