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Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in Northern Finland

Temporal changes over 20 years

¹ Department of Pediatrics, University of Oulu, Oulu University Hospital, Oulu, Finland
² Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
³ Department of Pediatrics, Tampere University Hospital, Tampere, Finland

Address correspondence and reprint requests to Riitta Veijola, University of Oulu, Oulu University Hospital, Department of Pediatrics P.O. Box 5000, 90014 Oulu, Finland. E-mail: riitta.veijola{at}oulu.fi

OBJECTIVE—To study the frequency of diabetic ketoacidosis (DKA) over a 20-year period among children diagnosed with type 1 diabetes in northern Finland.

RESEARCH DESIGN AND METHODS—The study population comprised 585 patients (328 boys) diagnosed with type 1 diabetes aged <15 years in the Department of Pediatrics, Oulu University Hospital, between 1 January 1982 and 31 December 2001. The data for clinical characteristics were collected retrospectively from the patients’ case records. The earlier 10-year period (1982–1991) was compared with the later 10-year period (1992–2001). Two definitions for DKA were used: DKA(i) pH <7.30 or DKA(ii) pH <7.30 and/or bicarbonate <15 mmol/l.

RESULTS—During the later 10-year period, children less often had DKA at diagnosis [DKA(i) 15.2 vs. 22.4%, P = 0.028, and DKA(ii) 18.9 vs. 29.5%, P = 0.003]. The proportion of young children aged <5 years at diagnosis increased over time, but the frequency of DKA also was lower in this age-group during 1992–2001 compared with the earlier 10-year period [DKA(i) 17.7 vs. 32.1%, P = 0.052, and DKA(ii) 20.3 vs. 42.6%, P = 0.005]. In children aged <2 years at diagnosis, the frequency of DKA remained high during 1992–2001 [DKA(i) 39.1% and DKA(ii) 47.8%].

CONCLUSIONS—The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period in northern Finland. However, children aged <2 years are still at high risk for DKA at diagnosis.

Abbreviations: DKA, diabetic ketoacidosis • DIPP, Type 1 Diabetes Prediction and Prevention Project

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