Childhood DKA prior to type 1 diabetes diagnosis linked to long-term problems

Children with diabetic ketoacidosis (DKA) at the time of their type 1 diabetes diagnosis are at risk of poor long-term glycemic control, a study has said.
New research has shown that having DKA before diagnosis predicts poorer control over many years, even when upbringing and how much the family earns is taken into account.
DKA is a serious complication of diabetes, which occurs when the body starts running out of insulin and instead develops a high level of ketones in the blood. If not treated, the outcome can lead to coma or even death.
The recent Canadian study, which was carried out across 15 years, looked at 4,000 children who were diagnosed with type 1 diabetes between 1998 and 2012.
The Barbara Davis Center for Diabetes and the University of Colorado researchers studied various factors such as demographic and socioeconomic backgrounds. They then found a link between a lack of health insurance and ethnicity in those who had DKA at diabetes diagnosis.
At the 15-year follow-up higher overall HbA1c levels were found in those who had DKA upon diabetes diagnosis, and continued to be present in almost 40 per cent of all cases.
Speaking to Medscape Medical News, study co-author Dr Arleta Rewers, an emergency physician in the University of Colorado’s department of pediatrics, said: “I think people do not realise the long-term implications of DKA. We’ve shown it persists for at least 15 years. This is how long we had data, but I’m pretty sure the effect lasts even beyond 15 years.
“It’s important for physicians to recognise that if a child presents with nausea and vomiting but not diarrhea it could potentially be diabetes and not gastroenteritis.”
The findings, which have been published in the Diabetes Care journal, could also help boost the Barbara Davis Center which wants to see autoantibody screening for type 1 diabetes being introduced.
The authors concluded: “DKA at diagnosis of type 1 diabetes is not just an acute complication but is also a harbinger of increased morbidity and mortality associated with poor glycemic control.
“Consequently, effective prevention of DKA at diagnosis may provide enduring benefits. Future studies are warranted to assess the effectiveness of DKA prevention at type 1 diabetes onset on improving long-term glycemic control.”