Ketoacidosis at type 1 diabetes diagnosis predicts poor long-term glycemic control
medwireNews: A study has found that children with diabetic ketoacidosis (DKA) at the diagnosis of type 1 diabetes have poor long-term glycemic control, independent of established demographic and socioeconomic risk factors.
Over a follow-up period of up to 15 years, 1297 children with DKA at diagnosis of type 1 diabetes – 39% of the study population – had glycated hemoglobin (HbA1c) levels that were 0.3–1.0% (3.3–10.9 mmol/mol) higher than those of children without DKA.
Furthermore, the researchers report “an apparent dose–response relationship between the severity of DKA and the average HbA1c during the entire follow-up period,” suggesting a possible causal relationship.
Multivariate analysis showed DKA at diagnosis to be an independent predictor of persistently elevated HbA1c levels, with HbA1c levels tracking at 0.9% (9.8 mmol/mol) and 1.4% (15.3 mmol/mol) higher in children with mild-to-moderate and severe DKA at diagnosis, respectively, compared with children without DKA.
The findings come from a prospective cohort study of more than 3300 Colorado residents who were diagnosed with type 1 diabetes in childhood. In addition to the long-term HbA1c association, children with DKA had higher levels HbA1c both at diagnosis of type 1 diabetes and 60 days later than those without the condition.
Children with DKA were younger, more often non-White or Hispanic, uninsured, or covered by a government-provided insurance plan, and less likely to have a ﬁrst-degree relative with type 1 diabetes than children without DKA.
Nonetheless, Arleta Rewers (University of Colorado, Aurora, USA) and co-researchers highlight that the association between DKA and HbA1c was “independent of demographic and socioeconomic factors (younger age, ethnic minority status, male sex) or access to care barriers that are associated with both DKA and long-term glycemic control.”
The current findings, published in Diabetes Care, show that DKA at diagnosis is not just an acute complication but, according to the researchers, “a harbinger of increased morbidity and mortality associated with poor glycemic control.”
They suggest that “[l]ower residual insulin secretion in children presenting with DKA may be at fault and could be prevented with earlier diagnosis,” adding that the “effective prevention of DKA at diagnosis may provide enduring benefits.”
By Catherine Booth
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