Long-acting insulin analogs and the risk of diabetic ketoacidosis in children and adolescents with type 1 diabetes

  1. for the DPV initiative and the German BMBF Competence Network Diabetes mellitus
  1. 1Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
  2. 2Department of Pediatrics, University of Leipzig, Leipzig, Germany
  3. 3University Children's Hospital Tübingen, Tübingen, Germany
  4. 4Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
  5. 5Department of Pediatrics, University of Homburg-Saar, Homburg-Saar, Germany
  6. 6Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
  7. 7Children's Hospital Paderborn, Paderborn, Germany
  8. 8Department of Epidemiology, University of Ulm, Ulm, Germany


Objective: To investigate if long-acting insulin analogs decrease the risk of diabetic ketoacidosis (DKA) in young individuals with type 1 diabetes.

Research design and methods: Of 48,110 type 1 diabetes patients prospectively studied between 2001 and 2008, the incidence of DKA requiring hospitalization was analyzed in 10,682 individuals aged ≤20 years with a diabetes duration of ≥2 years.

Results: The overall rate of DKA was 5.1 (SE ± 0.2)/100 patient-years. Patients using insulin glargine or detemir (n = 5317) had a higher DKA incidence than individuals using NPH insulin (n = 5365, 6.6 ± 0.4 vs. 3.6 ± 0.3, p < 0.001). The risk for DKA remained significantly different after adjustment for age at diabetes onset, diabetes duration, A1C, insulin dose, sex and migration background (p = 0.015, odds ratio 1.357 [1.062-1.734]).

Conclusions: Despite their long-acting pharmacokinetics, the use of insulin glargine or detemir is not associated with a lower incidence of DKA compared to NPH insulin.


    • Received December 10, 2009.
    • Accepted February 14, 2010.

This Article

  1. Diabetes Care
  1. Online Appendix
  2. All Versions of this Article:
    1. dc09-2249v1
    2. dc09-2249v2
    3. 33/5/1031 most recent