Reduced Prevalence of Diabetes Ketoacidosis at Diagnosis of Type 1 Diabetes in Young Children Participating in Longitudinal Follow-Up
- Helena Elding Larsson, MD, PHD1⇓,
- Kendra Vehik, PHD2,
- Ronny Bell, PHD3,
- Dana Dabelea, MD, PHD4,
- Lawrence Dolan, MD5,
- Catherine Pihoker, MD6,
- Mikael Knip, MD, PHD7,8,9,
- Riitta Veijola, MD, PHD10,
- Bengt Lindblad, MD, PHD11,
- Ulf Samuelsson, MD, PHD12,
- Reinhard Holl, MD13,
- Michael J. Haller, MD14,
- on behalf of the TEDDY Study Group,
- SEARCH Study Group,
- Swediabkids Study Group,
- DPV Study Group and
- Finnish Diabetes Registry Study Group*
- 1Department of Pediatrics, Skåne University Hospital, Lund University, Malmö, Sweden
- 2Pediatric Epidemiology Center, University of South Florida, Tampa, Florida
- 3Department of Epidemiology, Wake Forrest University, Winston-Salem, North Carolina
- 4Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
- 5Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- 6Department of Pediatrics, University of Washington, Seattle, Washington
- 7Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- 8Folkhälsan Research Center, Helsinki, Finland
- 9Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- 10Department of Pediatrics, University of Oulu, Oulu, Finland
- 11Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- 12Department of Health and Environment, Linköping University, Linköping, Sweden
- 13Institute of Epidemiology, University of Ulm, Ulm, Germany
- 14Department of Pediatrics, University of Florida, Gainesville, Florida
- Corresponding author: Helena Elding Larsson, .
H.E.L. and M.J.H. contributed equally to this work.
OBJECTIVE Young children have an unacceptably high prevalence of diabetic ketoacidosis (DKA) at the clinical diagnosis of type 1 diabetes. The aim of this study was to determine whether knowledge of genetic risk and close follow-up for development of islet autoantibodies through participation in The Environmental Determinants of Diabetes in the Young (TEDDY) study results in lower prevalence of DKA at diabetes onset in children aged <2 and <5 years compared with population-based incidence studies and registries.
RESEARCH DESIGN AND METHODS Symptoms and laboratory data collected on TEDDY participants diagnosed with type 1 diabetes between 2004 and 2010 were compared with data collected during the similar periods from studies and registries in all TEDDY-participating countries (U.S., SEARCH for Diabetes in Youth Study; Sweden, Swediabkids; Finland, Finnish Pediatric Diabetes Register; and Germany, Diabetes Patienten Verlaufsdokumenation [DPV] Register).
RESULTS A total of 40 children younger than age 2 years and 79 children younger than age 5 years were diagnosed with type 1 diabetes in TEDDY as of December 2010. In children <2 years of age at onset, DKA prevalence in TEDDY participants was significantly lower than in all comparative registries (German DPV Register, P < 0.0001; Swediabkids, P = 0.02; SEARCH, P < 0.0001; Finnish Register, P < 0.0001). The prevalence of DKA in TEDDY children diagnosed at <5 years of age (13.1%) was significantly lower compared with SEARCH (36.4%) (P < 0.0001) and the German DPV Register (32.2%) (P < 0.0001) but not compared with Swediabkids or the Finnish Register.
CONCLUSIONS Participation in the TEDDY study is associated with reduced risk of DKA at diagnosis of type 1 diabetes in young children.
- Received May 31, 2011.
- Accepted August 17, 2011.
- © 2011 by the American Diabetes Association.
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