Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

Marie-Eve Robinson; Patricia Li; Elham Rahme; Marc Simard; Isabelle Larocque; Meranda M Nakhla

doi:10.9778/cmajo.20190047

Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

CMAJ Open. 2019 May 14;7(2):E300-E305. doi: 10.9778/cmajo.20190047. Print 2019 Apr-Jun.

Authors

Marie-Eve Robinson¹, Patricia Li¹, Elham Rahme¹, Marc Simard¹, Isabelle Larocque¹, Meranda M Nakhla²

Affiliations

¹ Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.
² Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que. meranda.nakhla@mcgill.ca.

Abstract

Background: Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec.

Methods: We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis.

Results: We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age- and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03).

Interpretation: Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes.