KH. Chang, WH. Ting, YJ. Lee, CY. Huang, CH. Lin, SK. Huang, YC. Lee, LT. Wang, YE. Kao, YH. Wu, et al. (2026). Declining trends in diabetic ketoacidosis after type 1 diabetes Diagnosis: A 22-year experience at a pediatric medical center in Northern Taiwan. Pediatrics and neonatology. https://doi.org/10.1016/j.pedneo.2025.10.010

PubMed 41672856

[Abstract]
INTRODUCTION: Diabetic ketoacidosis (DKA) is a severe complication of type 1 diabetes (T1D). Hospitalizations for DKA after T1D diagnosis can serve as an indicator of diabetes care quality. Our study investigated the secular trend of DKA after T1D diagnosis in children and adolescents over 22 years and compared clinical characteristics of DKA at and after diagnosis.

MATERIALS AND METHODS: The study enrolled T1D patients under 18 years, followed at MacKay Children's Hospital from 2000 to 2022. DKA was defined by glucose ≥200 mg/dL, pH ≤ 7.3 or HCO3 ≤ 15 mmol/L, with positive ketones. DKA was further classified as AfterDx (DKA occurring >14 days after T1D diagnosis) and AtDx (within 14 days of diagnosis). Statistical analysis included ARIMA models for secular trend of AfterDx, chi-square and Fisher's exact tests for categorical data, and t-tests for continuous data. P-value < 0.05 was considered significant.

RESULTS: A total of 681 T1D patients contributed to 590 DKA episodes, of which 397 episodes were analyzed. There were 180 AfterDx episodes and 217 AtDx episodes. The AfterDx incidence declined between 2000 and 2022, especially after 2017, with an annual decrease of 43.1 %. Females (66.1 %) and adolescents (55.0 %) were more prevalent in the AfterDx group. In contrast, preschool children predominated in the AtDx group (43.3 %). Notably, 61.1 % of AfterDx episodes occurred within the first 6 years after T1D diagnosis.

CONCLUSION: Our study identified a statistically significant 43.1 % annual decline in AfterDx incidence from 2017 to 2022, reflecting advancements in diabetes care. Females and adolescents were high-risk groups, emphasizing the necessity for targeted interventions. Additionally, sixty percent of DKA episodes occurred within 6 years of T1D diagnosis, highlighting the importance of more diabetes education and enhanced monitoring during the early years after T1D diagnosis.