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Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control
Diabetes Care ( IF 14.8 ) Pub Date : 2017-09-01 , DOI: 10.2337/dc17-0558
Lindsey M. Duca 1, 2 , Bing Wang 1 , Marian Rewers 1 , Arleta Rewers 3
Affiliation  

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). HbA1c levels were measured an average of 2.8 times/year (median 20 HbA1c values/patient). A linear mixed model was used to examine the effect of DKA on long-term HbA1c levels, adjusting for age, race/ethnicity, sex, family history of diabetes, health insurance, and insulin pump use.

RESULTS DKA at diagnosis predicted persistently elevated HbA1c levels. Compared with children without DKA, HbA1c 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 HbA1c 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 HbA1c 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.



中文翻译:

诊断1型糖尿病时糖尿病酮症酸中毒预测长期血糖控制不良

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。

更新日期:2017-09-08
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