Since 1998, there has been an alarming increase in children with type 1 diabetes who have developed a dangerous complication by the time they are diagnosed with the disease, according to a new study. The research, published April 21 in the Journal of the American Medical Association (JAMA), found a 55 percent rise in the incidence of diabetic ketoacidosis (DKA), a potentially life-threatening diabetes-related condition.
DKA is characterized by dangerously high blood sugar and the presence of ketones, chemicals produced by the body when it breaks down fat for energy. According to the American Diabetes association, the body creates ketones when it doesn’t have enough insulin to use glucose. As ketones begin to build up they make blood more acidic and poison the body.
Symptoms of DKA include vomiting, excessive thirst and urine production, and abdominal pain that may be intense. Severe DKA may result in swelling of the brain tissue which can cause headache, coma and even lead to death.
Because little is known about the long-term trends in DKA in the U.S., researchers from the University of Colorado looked at the medical records of 3,439 patients younger than 18 who had been diagnosed with type 1 diabetes between 1998 and 2012. Of that group, 1,339 young people had also developed DKA.
Findings showed that kids with DKA were 54 percent male and 76 percent white, with a median age of 9.4 years. The total number of young people with DKA at the time of their type 1 diabetes diagnosis increased 55 percent over the course of the study, with a jump from 35 percent in 2007 to 46 percent in 2012.
The researchers, led by Arleta Rewers, MD, PhD, of the University of Colorado School of Medicine in Denver, noted that the only patient characteristic that changed over the course of their study was insurance, with public insurance increasing from 17.1 percent in 2007 to 37.5 percent in 2012. The study showed younger children and blacks were at a greater risk for developing DKA, while patients with private insurance and those with relatives who had type 1 diabetes were associated with a lower risk.
The findings, said the research team, point to delays in treatment for a growing number of kids with type 1 diabetes. The concern is that the incidence of DKA found in this study is consistent with incidences of the condition in countries with poor access to health care and low community and physician awareness in diabetes. Cases in the U.S. are much higher than in Canada or the U.K., the investigators said.
The authors attributed part of the problem of delayed diagnosis to the fact that families – and in some cases healthcare professionals – do not recognize the symptoms of type 1 diabetes. Economics too, come into play, they said.
“Increasing incidence of [DKA] correlated with an increase in Colorado child poverty prevalence from 10 percent in 2000 to 18 percent in 2012. The recent increase in [DKA] incidence among youth with private insurance may be related to the proliferation of high-deductible health plans,” the authors wrote.
The research team concluded “further research on the reasons for the increase and interventions to decrease the incidence is warranted.”