Reduced Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Young Children Participating in Longitudinal Follow-Up

• DOI: 10.2337/dc11-1026
• Publication Date: 2011-10-05T00:37:41Z
• Authors: Helena Elding Lar...; Kendra Vehik; Ronny Bell; Dana Dabelea; Lawrence Dolan; Catherine Pihoker; Mikael Knip; Riitta Veijola; Bengt Lindblad; Ulf Samuelsson; Reinhard Holl; Michael J. Haller
• Keywords: Blood Glucose; Male; Medicin och hälsovetenskap; Medical and Health Sciences; Diabetic Ketoacidosis; Islets of Langerhans; 03 medical and health sciences; 0302 clinical medicine; Humans; Genetic Predisposition to Disease; Longitudinal Studies; Age of Onset; Original Research; Autoantibodies; Data Collection; Incidence; Age Factors; Infant, Newborn; Infant; 16. Peace & justice; 3. Good health; Europe; Diabetes Mellitus, Type 1; Child, Preschool; Population Surveillance; Female; Follow-Up Studies

OBJECTIVE Young children have an unacceptably high prevalence of diabetic ketoacidosis (DKA) at the clinical diagnosis of type 1 diabetes. The aim of this study was to determine whether knowledge of genetic risk and close follow-up for development of islet autoantibodies through participation in The Environmental Determinants of Diabetes in the Young (TEDDY) study results in lower prevalence of DKA at diabetes onset in children aged <2 and <5 years compared with population-based incidence studies and registries.

RESEARCH DESIGN AND METHODS Symptoms and laboratory data collected on TEDDY participants diagnosed with type 1 diabetes between 2004 and 2010 were compared with data collected during the similar periods from studies and registries in all TEDDY-participating countries (U.S., SEARCH for Diabetes in Youth Study; Sweden, Swediabkids; Finland, Finnish Pediatric Diabetes Register; and Germany, Diabetes Patienten Verlaufsdokumenation [DPV] Register).

RESULTS A total of 40 children younger than age 2 years and 79 children younger than age 5 years were diagnosed with type 1 diabetes in TEDDY as of December 2010. In children <2 years of age at onset, DKA prevalence in TEDDY participants was significantly lower than in all comparative registries (German DPV Register, P < 0.0001; Swediabkids, P = 0.02; SEARCH, P < 0.0001; Finnish Register, P < 0.0001). The prevalence of DKA in TEDDY children diagnosed at <5 years of age (13.1%) was significantly lower compared with SEARCH (36.4%) (P < 0.0001) and the German DPV Register (32.2%) (P < 0.0001) but not compared with Swediabkids or the Finnish Register.

CONCLUSIONS Participation in the TEDDY study is associated with reduced risk of DKA at diagnosis of type 1 diabetes in young children.