Burden of diabetic ketoacidosis still unacceptably high
Diabetic ketoacidosis (DKA), a life-threatening but preventable condition, remains an important problem for youth with diabetes and their families. Diabetic ketoacidosis is due to a severe lack of insulin and it is often the presenting symptom of type 1 diabetes. It can also be present at the onset of type 2 diabetes.
SEARCH for Diabetes in Youth, a multi-center, multiethnic study of childhood diabetes, is the largest surveillance effort of diabetes among youth under the age of 20 conducted in the United States to date. The study covers 5 locations across the country where about 5.5 million children live.
In a report in the April, 2014, issue of the Pediatrics, study investigators analyzed data from 5615 youth with type 1 and 1425 youth with type 2 diabetes newly diagnosed between 2002 and 2010. The study, led by Dana Dabelea, MD, PhD, professor and associate dean at the University of Colorado School of Public Health, shows that the frequency of DKA at diagnosis in U.S. youth with type 1 diabetes did not decline over the last 8 years, but remained high compared with other developed countries, with almost a third of all youth with type 1 diabetes presenting in DKA. Rates were disproportionately high in children younger than 5 years of age, non-White racial/ethnic groups, youth without private health insurance and those with lower family income. Among youth with type 2 diabetes, DKA was much less common and decreased over time, suggesting improved detection or earlier diagnosis of diabetes.
Dabelea says "These data suggest that more needs to be done to begin reducing DKA rates in the future. Previous research suggests that increased community awareness of type 1 diabetes, including parental education and closer monitoring of signs and symptoms of diabetes, may be effective tools. In the U.S., improved health care access especially for underserved populations is also needed to reduce the observed health disparities."
SEARCH has estimated that there were at least 188,811 youth with diabetes in the U.S. in 2009: 168,141 with type 1 diabetes and 19,147 with type 2 diabetes. In the U.S. and worldwide, the incidence of type 1 diabetes in youth has been increasing by 3% to 4% per year, with limited estimates for type 2 diabetes except in minority populations in whom increased prevalence has also been reported.