Ketoacidosis in Newly Diagnosed Type 1 Diabetes in Children and Adolescents in Israel: Prevalence and Risk Factors

Background: Diabetic ketoacidosis (DKA) as the first presentation of type 1 diabetes mellitus (T1DM) is a serious complication that is preventable. Objectives: To identify risk factors for DKA at presentation of T1DM to delineate high-risk Israeli populations that could benefit from preventative measures. Methods: Data for this multicenter retrospective study were collected from the medical files of three pediatric diabetes centers representing three districts in Israel. Inclusion criteria were diagnosis of T1DM, age at diagnosis <= 17 years, permanent residency in Israel, and documentation of the presence, or absence of DKA at presentation. Results: The study population included 607 patients of whom 438 met the inclusion criteria. The mean age at diagnosis was 9.1 +/- 4.5 years. DKA was present at diagnosis in 156/438 patients (35.6%). The incidence of DKA was different among the three diabetes centers (P = 0.04). The DKA group was significantly younger than the non-DKA group (8.4 +/- 4.5 vs. 9.5 +/- 4.4, respectively, P = 0.008). DKA was significantly associated with maternal origin (Ashkenazi Jewish origin [lower] vs. non-Ashkenazi, P = 0.04) and with paternal education level (academic [lower] vs. non-academic education, P = 0.04). Stepwise logistic regression showed that maternal Ashkenazi Jewish origin has a protective effect on DKA (odds ratio [OR] 0.4, 95% confidence interval [95%Cl] 0.21-0.74, P = 0.004) and that younger age is an independent risk factor (OR 1.06, 95%Cl 1.01-1.1, P = 0.02). Conclusions: A diabetes educational program targeting high risk population groups may reduce the prevalence of DKA nationwide.