Diabetic ketoacidosis (DKA) occurs at a rate of five to seven per cent in children with established children with type 1 diabetes, according to new research.
The study, conducted by researchers from the Barbara Davis Centre for Childhood Diabetes, Aurora, Colorado, examined children with type 1 diabetes from a number of countries, including the United Kingdom, the United States, and several from Western Europe.
The researchers analysed the data of nearly 50,000 patients with type 1 diabetes below the age of 18, all of whom had had type 1 diabetes for more than a year. They found that the risk of diabetic ketoacidosis was particularly high among young girls, ethnic minorities, and those with higher HbA1c levels.
Dr. David M. Maahs, lead author of the study, told Medscape Medical News:
“DKA continues to be a major problem in pediatric type 1 diabetes. Programs need to be developed and funded to target patients at high risk.”
Diabetic ketoacidosis is a severe complication of diabetes that occurs when blood sugars are allowed to rise too high for too long. Without insulin, the body cannot access glucose from the blood for energy. Without glucose from the blood, the cells have to get their energy from the body’s reserves of fat, a process which leads to the production of ketones. A small amount of ketones production is perfectly normal, but when the process goes on for too long the ketones can get into the bloodstream, which can lead to coma and, in some cases, death.
Type 1 diabetes in children is often undiagnosed before ketoacidosis sets i, because the lack of insulin production means that glucose levels rise and rise without being controlled at all. This study suggests that DKA remains a problem for children with established type 1 diabetes, who will be taking insulin and understand that they have the condition.
And according to the researchers, there is no easy solution to the problem.
“This is of course a very complex issue with many aspects besides patient education, [including] the accessibility of the healthcare system, availability of 24-hour access (for example, by telephone hotline for families with affected children), issues of insurance and reimbursement, distance between family home and emergency care as well as specialised pediatric diabetes care, [and] availability of frequent blood glucose testing,” said study co-author Reinhard W. Holl, of the University of Ulm, German Centre for Diabetes research.
Other causes may include the fairly common practice among diabetic teenagers of not taking insulin in order to lose weight. Without insulin, the body cannot store glucose as fat.
More information about specific cases of diabetic ketoacidosis in children with established type 1 diabetes is needed before a solution can be found, according to Dr. Holl:
“We […] need more information on the psychological and social background of high-risk groups to better target prevention programs…Comparison of outcomes among different healthcare systems despite similar resources may open new ideas on how to improve long-term care in chronically ill children,” Dr. Holl told Medscape Medical News.
The findings were published in Diabetes Care.

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