Increasing Trends in Hospitalisation With Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis Among Children and Youth in the United States and England, 2002–2020
Authors' conclusion
This study found a relative increase in the proportion of children presenting with DKA at T1D diagnosis, occurring in parallel with rising T1D incidence.
Study context
- Population
- Children and youth with incident T1D, US (Medicaid, MarketScan) and England (Clinical Practice Research Datalink (CPRD)), 2002–2020; mean (SD) age 10.4 (4.9), 46.8% female
- Participants
- 116,845 children
- Exposure
- Trends in diabetic ketoacidosis (DKA) at T1D diagnosis across Medicaid, MarketScan and CPRD cohorts
- Outcome
- DKA at diagnosis: DKA hospitalisation within 30 days prior to T1D diagnosis
Methodological detailspopulation-based, multinational (US and England), claims and electronic health record data
- Population-based
- Multinational (US and England)
- Claims and electronic health record data
Main finding
As reported in the abstract
DKA at T1D diagnosis · 2002–2020
DKA at T1D diagnosis · 2002–2020 Medicaid 34.4% to 45.5% (2002–2019); 52.4% (2020) · MarketScan 42.0% to 44.8% (2002–2019); 52.9% (2020) · CPRD 17.9% to 36.5% (2002–2019); 44.1% (2020)
Rise 2002–2019
- Overall presenting in DKA
- 48 291 (41.3%)
Observational data: associations, not effects.
Further findings
RR of DKA by subgroup
| RR (95% CI) | ||
|---|---|---|
| Children under 2 years | 1.97 (1.92–2.02) | |
| Black children | 1.14 (1.06–1.23) | |
| Hispanic children | 1.12 (1.10–1.15) | |
| Higher social vulnerability areas | 1.20 (1.02–1.40) | |
| 0.512Relative risk (log scale) |
| Outcome | Medicaid | MarketScan | CPRD |
|---|---|---|---|
| T1D incidence per 100 000 children · 2002–2019; 2020 | 10 to 17; 21 in 2020 per 100 000 children | 12 to 20; 22 in 2020 per 100 000 children | 5 to 13; 15 in 2020 per 100 000 children |
DKA proportion by subgroup
- Aged 6 months to 2 years
- 70.4%
- Black
- 45.4%
- Hispanic
- 45.4%
Original publication
Increasing Trends in Hospitalisation With Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis Among Children and Youth in the United States and England, 2002–2020. Diabetes Obes Metab. Published 27 August 2026. doi:10.
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