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

Journal

CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603

Informations de publication

Date de publication:
Historique:
entrez: 16 5 2019
pubmed: 16 5 2019
medline: 16 5 2019
Statut: epublish

Résumé

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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.9778/cmajo.20190047 PMID: 31088804 PMC: PMC6517121
pubmed: 31088804
pii: 7/2/E300
doi: 10.9778/cmajo.20190047
pmc: PMC6517121
doi:

Types de publication

Journal Article

Langues

eng

Pagination

E300-E305

Informations de copyright

Copyright 2019, Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Meranda Nakhla received a lecture fee from the Quebec Association of Endocrinologists. No other competing interests were declared.

Références

Diabetes Care. 1999 Jan;22(1):7-9
pubmed: 10333896
Arch Dis Child. 1999 Oct;81(4):318-23
pubmed: 10490436
Diabetes Care. 1999 Dec;22(12):1950-5
pubmed: 10587824
Diabetologia. 2001 Mar;44(3):290-7
pubmed: 11317658
Pediatrics. 2002 Jan;109(1):40-4
pubmed: 11773540
Diabetes Care. 2005 Oct;28(10):2384-7
pubmed: 16186267
Diabetes Care. 2007 Apr;30(4):861-6
pubmed: 17392547
Lancet. 2009 Jun 13;373(9680):2027-33
pubmed: 19481249
Pediatr Diabetes. 2010 Mar;11(2):122-8
pubmed: 19500278
Diabetes Care. 2009 Sep;32(9):1647-8
pubmed: 19549730
J Pediatr. 2010 Mar;156(3):472-7
pubmed: 19962155
Diabetes Care. 2010 Apr;33(4):786-91
pubmed: 20067956
Diabetologia. 2010 Jun;53(6):1057-61
pubmed: 20213235
Pediatrics. 2010 Jun;125(6):1119-26
pubmed: 20498170
Pediatrics. 1991 Jul;88(1):98-104
pubmed: 2057278
Diabetes Care. 2011 Apr;34(4):898-903
pubmed: 21378211
BMJ. 2011 Jul 07;343:d4092
pubmed: 21737470
Diabet Med. 2012 Aug;29(8):e170-5
pubmed: 22486389
Pediatr Diabetes. 2012 Dec;13(8):647-51
pubmed: 22816992
Can J Public Health. 2012 Apr 30;103(8 Suppl 2):S17-22
pubmed: 23618066
Pediatrics. 2013 Aug;132(2):229-36
pubmed: 23878044
Diabetes Metab. 2014 Apr;40(2):137-42
pubmed: 24332018
Pediatrics. 2014 Apr;133(4):e938-45
pubmed: 24685959
Chronic Dis Inj Can. 2014 Nov;34(4):226-35
pubmed: 25408182
Arch Pediatr. 2015 Mar;22(3):241-6
pubmed: 25656455
JAMA. 2015 Apr 21;313(15):1570-2
pubmed: 25898057
Pediatr Diabetes. 2016 Jun;17(4):266-73
pubmed: 25951940
Sci Rep. 2015 May 19;5:10358
pubmed: 25989414
Pediatr Clin North Am. 2015 Aug;62(4):857-71
pubmed: 26210621
CMAJ Open. 2016 Apr 19;4(2):E141-6
pubmed: 27398356
BMJ Open Diabetes Res Care. 2016 Jun 22;4(1):e000239
pubmed: 27547416
Pediatr Diabetes. 2018 Mar;19(2):320-328
pubmed: 28568379
Diabetes Care. 2017 Sep;40(9):1249-1255
pubmed: 28667128
CMAJ Open. 2017 Jul 24;5(3):E586-E593
pubmed: 28747349
Pediatr Diabetes. 2018 May;19(3):501-505
pubmed: 28857360
CMAJ. 2018 Apr 9;190(14):E416-E421
pubmed: 29632036
Pediatr Diabetes. 2019 Mar;20(2):172-179
pubmed: 30556249
Diabetologia. 1987 Jul;30(7):453-9
pubmed: 3311859

Auteurs

Marie-Eve Robinson (ME)

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.

Patricia Li (P)

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.

Elham Rahme (E)

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.

Marc Simard (M)

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.

Isabelle Larocque (I)

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 M Nakhla (MM)

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.

Classifications MeSH