OBJECTIVE This study tested the hypothesis that diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control independently of established risk factors.

RESEARCH DESIGN AND METHODS This was a prospective cohort study of 3,364 Colorado residents diagnosed with type 1 diabetes before 18 years of age, in 1998–2012, and monitored for up to 15 years. Of those, 1,297 (39%) had DKA at diagnosis (blood glucose >250 mg/dL, and venous pH <7.3 or bicarbonate <15 mEq/L). Severity of DKA was further classified as mild/moderate (pH 7.10–7.29 or bicarbonate 5–14 mEq/L) or severe (pH <7.10 or bicarbonate <5 mEq/L). HbA_1c levels were measured an average of 2.8 times/year (median 20 HbA_1c values/patient). A linear mixed model was used to examine the effect of DKA on long-term HbA_1c levels, adjusting for age, race/ethnicity, sex, family history of diabetes, health insurance, and insulin pump use.

RESULTS DKA at diagnosis predicted persistently elevated HbA_1c levels. Compared with children without DKA, HbA_1c tracked 1.4% (15.3 mmol/mol) higher in those with severe DKA (P < 0.0001) and 0.9% (9.8 mmol/mol) higher in those with mild/moderate DKA at diagnosis (P < 0.0001). These effects were independent of ethnic minority status or lack of health insurance at diagnosis that predicted higher HbA_1c by 0.5% (5.5 mmol/mol; P < 0.0001) and 0.2% (2.2 mmol/mol; P < 0.0001), respectively. Insulin pump use or having a parent or sibling with type 1 diabetes predicted lower long-term HbA_1c by, respectively, 0.4% (4.4 mmol/mol; P < 0.0001) and 0.2% (2.2 mmol/mol; P = 0.01).

CONCLUSIONS DKA at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control, independent of demographic and socioeconomic factors.

目的本研究检验了以下假说：糖尿病酮症酸中毒（DKA）在诊断儿童1型糖尿病时可预测长期血糖控制不良，而与既定的危险因素无关。

研究设计与方法这是一项前瞻性队列研究，研究对象是1998年至2012年在18岁之前被诊断患有1型糖尿病的3,364名科罗拉多州居民，并进行了长达15年的监测。其中1,297名（39％）在诊断时具有DKA（血糖> 250 mg / dL，静脉pH <7.3或碳酸氢盐<15 mEq / L）。DKA的严重程度进一步分为轻度/中度（pH 7.10-7.29或碳酸氢盐5-14 mEq / L）或重度（pH <7.10或碳酸氢盐<5 mEq / L）。每年平均测量HbA _1c水平2.8次（中位数20 HbA _1c /患者）。使用线性混合模型检查DKA对长期HbA _1c水平的影响，并调整年龄，种族/民族，性​​别，糖尿病家族史，健康保险和使用胰岛素泵。

结果诊断中的DKA预测HbA _1c水平持续升高。与没有DKA的儿童相比，诊断为重度DKA的儿童HbA _1c升高1.4％（15.3 mmol / mol）（P <0.0001），患有轻度/中度DKA的儿童HbA _1c升高0.9％（9.8 mmol / mol）（P < 0.0001）。这些影响与少数族裔身份或诊断时缺乏健康保险无关，后者预测HbA _1c分别升高0.5％（5.5 mmol / mol; P <0.0001）和0.2％（2.2 mmol / mol; P <0.0001）。胰岛素泵的使用或患有1型糖尿病的父母或兄弟姐妹预测较低的长期HbA _1c分别为0.4％（4.4mmol / mol；P＜0.0001）和0.2％（2.2mmol / mol；P＝ 0.01）。

结论DKA诊断儿童1型糖尿病的预测长期血糖控制不佳，与人口统计学和社会经济因素无关。