Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Long-term HbA 1c in 7,961 Children and Young Adults in the Australasian Diabetes Data Network Diabetes Care 2022;45:2918–2925 | https://doi.org/10.2337/dc22-0853 Helen F. Clapin, 1,2 Arul Earnest, 3 Peter G. Colman, 4,5 Elizabeth A. Davis, 1,2 Craig Jefferies, 6 Kym Anderson, 7 Melissa Chee, 8 Philip Bergman, 3,9 Martin de Bock, 10,11 Kung-Ting Kao, 5,12,13 P. Gerry Fegan, 14 D. Jane Holmes-Walker, 15 Stephanie Johnson, 16 Bruce R. King, 17 Meng Tuck Mok, 18 Kruthika Narayan, 19,20 Alexia S. Pe~ na Vargas, 21 Richard Sinnott, 5 Benjamin J. Wheeler, 22 Anthony Zimmermann, 23 Maria E. Craig, 19,20 Jenny J. Couper, 21 and the ADDN Study Group* OBJECTIVE The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabe- tes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA 1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA 1c . RESEARCH DESIGN AND METHODS Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect mod- els related variables to HbA 1c . RESULTS DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (inter- quartile range 3.2, 9.4) years of follow-up, participants with severe, but not moder- ate or mild, DKA at diagnosis had a higher mean HbA 1c (+0.23%, 95% CI 0.11,0.28; [+2.5 mmol/mol, 95% CI 1.4,3.6]; P < 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA 1c (20.28%, 95% CI 20.31, 20.25; [23.1 mmol/mol, 95% CI 23.4, 22.8]; P < 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA 1c . Indigenous status was associated with higher HbA 1c (+1.37%, 95% CI 1.15, 1.59; [+15.0 mmol/mol, 95% CI 12.6, 17.4]; P < 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52; [+4.7 mmol/mol, 95% CI 3.4, 5.6]; P < 0.001). CONCLUSIONS Severe, but not mild or moderate, DKA at diagnosis was associated with a mar- ginally higher HbA 1c over time, an effect that was modified by use of CSII. Indige- nous status and lower socioeconomic status were independently associated with higher long-term HbA 1c . Diabetic ketoacidosis (DKA) is a life-threatening complication that occurs frequently at the onset of type 1 diabetes in children and adolescents, causing physical and 1 Perth Children’ s Hospital, Nedlands, Western Australia, Australia 2 Telethon Kids Institute, Nedlands, Western Australia, Australia 3 Monash University, Clayton, Victoria, Australia 4 Royal Melbourne Hospital, Parkville, Victoria, Australia 5 The University of Melbourne, Parkville, Victoria, Australia 6 Starship Children’ s Health, Grafton, Auckland, New Zealand 7 Barwon Health, Geelong, Victoria, Australia 8 JDRF Australia, St Leonards, New South Wales, Australia 9 Monash Children’ s Hospital, Clayton, Victoria, Australia 10 Canterbury District Health Board, Christchurch, New Zealand 11 Christchurch School of Medicine, University of Otago, Otago, New Zealand 12 Royal Children’ s Hospital, Parkville, Victoria, Australia 13 Murdoch Children’ s Research Institute, Parkville, Victoria, Australia 14 Fiona Stanley Hospital, Murdoch, Western Australia, Australia 15 Westmead Hospital, Westmead, New South Wales, Australia 16 Queensland Children’ s Hospital, South Brisbane, Queensland, Australia 17 John Hunter Children’ s Hospital, New Lambton Heights, New South Wales, Australia EPIDEMIOLOGY/HEALTH SERVICES RESEARCH 2918 Diabetes Care Volume 45, December 2022 Downloaded from http://diabetesjournals.org/care/article-pdf/45/12/2918/697367/dc220853.pdf by guest on 29 April 2024