Factors Predicting Diabetic Ketoacidosis at Commencement of Type 1 Diabetes among Pediatric Patients

The emergence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) stays risky. After a 2011 systematic review, numerous additional articles were published, and the review required updating.

The present study assessed factors linked with DKA at the onset of T1D among pediatric patients.

It searched PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists using the population, intervention, comparison, and outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years.

The findings of the search were as follows-

• Among the 2565 articles recognized, 149 were included, with the addition of 46 from the previous review (a total of 195 articles). 
• Thirty-eight factors were pinpointed and analyzed for their association with DKA at T1D onset. 
• Factors linked with increased risk of DKA were younger age at T1D onset, belonging to an ethnic minority population, and having a family history of T1D, agreeing with the 2011 systematic review. 
• A few factors were not linked to DKA in the 2011 systematic review but were linked with DKA in the recent review (e.g., delayed diagnosis). 
• Additional factors linked with DKA risk among patients with new-onset T1D included participation in screening programs and presentations during the COVID-19 pandemic.

This study shows that ages younger than two years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and showing during the COVID-19 pandemic are associated with a raised risk of DKA. Factors that decrease the risk of DKA include greater knowledge of key signs or symptoms of DKA, like a family history of T1D or participation in screening programs. Future work should identify and implement strategies concerning these elements to diminish the risk of DKA among new patients with T1D.

Rugg-Gunn CEM, Dixon E, Jorgensen AL, et al. Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review. JAMA Pediatr. 2022;176(12):1248–1259. doi:10.1001/jamapediatrics.2022.3586