Background: Diabetic ketoacidosis (DKA) is the leading cause of death in children and adolescents with Type 1 Diabetes Mellitus (T1DM), with mortality rates higher among newly diagnosed subjects. DKA at presentation occurs more frequently among children under 5 years of age, from a low socioeconomic level and without family history of diabetes. The worldwide rates of DKA at diagnosis vary between countries and between different areas in the same country, ranging from 15 to 70%. In Israel the estimated prevalence of DKA at presentation is 35-55% for all age groups. Despite an increase in the disease prevalence, there has not been any reduction in the rate of DKA over the past years.
Objective: To examine the epidemiology of DKA at presentation of T1DM in Israel and determine prevalence and risk factors in order to implement effective intervention methods for prevention of DKA in risk groups.
Methods: Data from the national registry at The Gertner Institute at Chaim Sheba Medical Center, Tel Hashomer, including all children (age 0 to 17 years) who were diagnosed with T1DM between 2004 and 2008, was collected. In addition, a retrospective chart review of subjects with T1DM from three medical centers in Israel was conducted.
Results: The study included 1450 cases from the national registry at The Gertner Institute and 438 cases from the three medical centers. During the study period the rate of DKA was steady at around 39%. Demographic variables that were found to be associated with DKA at diagnosis in Israel were: 1. Young age- DKA at presentation was significantly more common among children under 6 years of age compared to 6 to 10 years and 11 to 18 years old (47% vs. 39% vs. 35%, respectively, p<0.01), 2. Maternal origin- Ashkenazi origin was found to be a protective factor (OR 0.43, p=0.04), 3. District of living – the rate of DKA was 49% in Jerusalem area, 41% in northern Israel, 36% in central Israel and 34% in southern Israel (P=0.04), and 4. First degree relative with T1DM – DKA at presentation was significantly less common with first degree relative with T1DM compared to none (22% vs. 41% respectively, p<0.01).
Conclusions: The study identified risk factors for DKA as presentation of T1DM in Israel. Increasing the knowledge among population at risk about symptoms and signs of diabetes may allow earlier detection of T1DM and prevention of DKA at presentation.
