Diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). This article examines the factors associated with DKA in children with T1DM, both at first presentation and in recurrent cases. The challenge for future research is to find effective ways to improve primary care physician and general community awareness of T1DM to reduce DKA at presentation and develop practical, cost-effective programs to reduce recurrent DKA.
Key points
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Diabetic ketoacidosis (DKA) is a complication of severe insulin deficiency leading to hyperglycemia, with its attendant glycosuria, dehydration, and ketogenesis, leading to acidosis.
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DKA is associated with significant morbidity, non-negligible mortality, and excessive health care expenditures.
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DKA is largely an avoidable and preventable complication of type 1 diabetes mellitus (T1DM).
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Risk factors associated with DKA at diagnosis of T1DM include age less than 5 years old, lack of private health insurance, lower socioeconomic status (SES), misdiagnosis, delayed diagnosis, and living in regions with a low background incidence of T1DM.
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Factors associated with increased DKA risk in children with established T1DM include age greater than 13 years, female gender, low SES, lack of private health insurance, poor family functioning, psychiatric disorders, higher reported insulin dose, and poor glycemic control.
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