Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA(1c) levels

S Fredheim, J Johannesen, A Johansen, Lene Lyngsøe, H Rida, Marie Louise Charlotte M Andersen, Mads Lauridsen, Birgitte Hertz, Niels Birkebæk, B Olsen, H B Mortensen, J Svensson, the Danish Society for Diabetes in Childhood and Adolescence

38 Citations (Scopus)

Abstract

Aims/hypothesis: We investigated the long-term impact of diabetic ketoacidosis (DKA) at onset on metabolic regulation and residual beta cell function in a Danish population with type 1 diabetes. Methods: The study is based on data from DanDiabKids, a Danish national diabetes register for children. The register provides clinical and biochemical data on patients with type 1 diabetes diagnosed in 1996-2009 and then followed-up until 1 January 2012. Repeated-measurement models were used as statistical methods. Results: The study population comprised 2,964 children <18 years. The prevalence of DKA at diagnosis was 17.9%. Of the total subjects, 8.3% had mild, 7.9% had moderate and 1.7% had severe DKA. DKA (moderate and severe) was associated with increased HbA1c (%) levels (0.24; 95% CI 0.11, 0.36; p = 0.0003) and increased insulin dose-adjusted HbA1c (IDAA1c, 0.51; 95% CI 0.31, 0.70; p < 0.0001) during follow-up, after adjustment for covariates. Children without a family history of diabetes were more likely to present with DKA (19.2% vs 8.8%, p < 0.0001); however, these children had a lower HbA 1c (%) level over time (-0.35; 95% CI -0.46, -0.24; p < 0.0001). Continuous subcutaneous insulin infusion (CSII) was associated with a long-term reduction in HbA1c, changing the effect of DKA, after adjustment for covariates (p < 0.0001). Conclusions/interpretation: DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA1c and IDAA1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population.

Original languageEnglish
JournalDiabetologia
Volume56
Issue number5
Pages (from-to)995-1003
Number of pages9
ISSN0012-186X
DOIs
Publication statusPublished - May 2013

Fingerprint

Dive into the research topics of 'Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA(1c) levels'. Together they form a unique fingerprint.

Cite this