Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study

• Published in: PloS one 2019-06, Vol.14 (6), p.e0218807
• Main Authors: Manuwald, Ulf, Schoffer, Olaf, Hegewald, Janice, Große, Johann, Kugler, Joachim, Kapellen, Thomas Michael, Kiess, Wieland, Rothe, Ulrike
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Age factors; Analysis; Birth weight; Child; Child health; Child, Preschool; Children; Childrens health; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetic ketoacidosis; Diabetic Ketoacidosis - epidemiology; Diagnosis; Female; Follow-Up Studies; Genetics; Germany - epidemiology; Girls; Glucose; Health sciences; Hospitals; Humans; Incidence; Infant; Infant, Newborn; Insulin; Juvenile diabetes; Ketoacidosis; Male; Medical diagnosis; Medical personnel; Medical research; Medicine; Medicine and Health Sciences; Pediatrics; People and Places; Physical Sciences; Physicians; Poisson density functions; Population; Population studies; Population-based studies; Public health; Registries; Regression analysis; Research and Analysis Methods; Risk factors; Statistical analysis; Statistical methods; Statistical significance; Studies; Teenagers; Type 1 diabetes; Urination disorders
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0218807

The aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016. The population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0-14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression. The rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years. Due to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes.