Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children

  1. Jacqueline R. Curtis, MD1,
  2. Teresa To, PHD2,
  3. Sarah Muirhead, MD3,
  4. Elizabeth Cummings, MD4 and
  5. Denis Daneman, MB, BCH12
  1. 1Department of Pediatrics, Division of Endocrinology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  2. 2Population Health Sciences Program, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Pediatrics, Division of Endocrinology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Department of Pediatrics, Division of Endocrinology, the IWK Hospital, Dalhousie University, Nova Scotia, Halifax, Canada


    OBJECTIVE—To investigate trends and geographic variation in diabetic ketoacidosis (DKA) hospitalization rates among children in Ontario from 1991 to 1999.

    RESEARCH DESIGN AND METHODS—Canadian Institute for Health Information (CIHI) data were used to identify 15,872 diabetes-related hospital admissions in children younger than 19 years in Ontario from 1991 to 1999. Of these, 5,008 admissions were because of DKA and 10,864 admissions were because of conditions other than DKA (non-DKA). Small area variation analysis was used to compare areas with high versus low DKA admission rates.

    RESULTS—There was a 19% relative decrease in the overall diabetes admission rate over the study period. Non-DKA admissions decreased by 29%, whereas DKA admissions remained stable. Total days of care decreased by 393 days per year for non-DKA admissions and by 99 days per year for DKA admissions. The average length of hospital stay decreased from 4.9 to 3.5 days for non-DKA admissions and from 4.5 to 3.2 days for DKA admissions. The fatality rate was 0.19% for non-DKA admissions and 0.18% for DKA admissions. Variation across geographic areas remained stable for DKA over the study period (Kendall’s correlation coefficient 0.64, P = 0.017) with an average 3.7-fold difference between the lowest and highest regions.

    CONCLUSIONS—Increased ambulatory care efforts for children with type 1 diabetes in Ontario have successfully reduced non-DKA admission rates. However, DKA admission rates have remained stable. Geographic variation for DKA admissions is low, but the observed 3.7-fold difference is clinically important for a preventable complication with a significant potential for long-term morbidity and mortality. Prevention strategies are needed, particularly in areas identified with the highest rates.


    • Address correspondence and reprint requests to Denis Daneman, MB, BCH, The Hospital for Sick Children, Room 5110 Elm Wing, Division of Endocrinology, 555 University Ave., Toronto, Ontario, Canada M5G 1X8. E-mail: denis.daneman{at}

      Received for publication 12 July 2001 and accepted in revised form 25 May 2002.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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