Background: DKA in children and adolescents with established type 1 diabetes (T1D) is a major problem with considerable cost to patients, families and health care systems. Many consider it as a quality of care indicator and a failure of relationship between the care provider and the family/patient. Considerable variability in rates are recognized. We analyzed multicenter registry and audit data from five countries with similarly advanced, yet differing, health care systems.
Objective and hypotheses: Data from 59 191 individuals <18 years with T1D from the T1D exchange (n=13 966, United States), the National Pediatric Diabetes Audit (n=18 963, England and Wales) and the DPV initiative (n=26 262, Austria and Germany) were pooled. DKA was defined as ≥1 hospitalization with a pH<7.3 during the prior year. Data were analyzed using multivariable logistic regression models for the whole population.
Results: The mean rate for DKA was 5.3% with differences amongst countries (6.2% US, 6.0% England, 4.5% Germany, 4.4% Wales, 3.3% Austria) which persisted after demographic adjustment (P<0.0001). Risk of DKA was highest in adolescents (1418 years: 5.8%) compared to younger children (610 years: 3.4%; P<0.0001). DKA increased with longer duration of diabetes from 3.5% (<2 years) to 5.9% (≥2 years, P<0.0001). DKA was higher in girls compared to boys (OR=1.34 (1.241.44)). DKA was more prevalent in patients with ethnic minority status (OR=1.32 (1.211.43)). Additionally, DKA risk was lower in patients on insulin pumps (OR=0.88 (0.810.96)).
Conclusion: These multicenter data demonstrate important differences in DKA in childhood T1D across five nations. Benchmarking data such as these are important so countries can learn from each other to better understand where to target interventions in order to improve quality of care.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology