JH. Wersäll, P. Adolfsson, J. Ekelund, G. Forsander, K. Åkesson and R. Hanas (2025). Is diabetic ketoacidosis at diagnosis of type 1 diabetes associated with secondary episodes of ketoacidosis? A nationwide longitudinal study of Swedish children from 2012 to 2019. Diabetes research and clinical practice, 225, 112282. https://doi.org/10.1016/j.diabres.2025.112282

PubMed 40436353

[Abstract]
AIMS: The primary aim was to analyze if diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children is associated with an increased risk of future DKA episodes. Secondary aims were to assess the effects of parental education level and family income on the risk of recurrent DKA.

METHODS: This was a national, retrospective cohort study of children aged 9 months to < 18 years with type 1 diabetes in Sweden from January 1, 2012, to December 31, 2019. DKA was defined as pH < 7.30. Cox proportional hazards models were used to estimate the risk of DKA with adjustments for sex, age, disposable income and parental education level.

RESULTS: A total of 4523 children were included in the study, of whom 909 (20.1 %) had DKA at diagnosis of type 1 diabetes. DKA at diagnosis was not associated with increased risk of another DKA episode during established diabetes (HR 0.77, p = 0.46, 95 %C.I. 0.41-1.51). Low parental education level and low household income were independent predictors of DKA during established diabetes.

CONCLUSIONS: DKA at diagnosis of type 1 diabetes does not predict further episodes of DKA. Adverse social determinants of health likely predict long-term increased risk of DKA episodes.