Rising Charges and Widening Socioeconomic Disparities in Diabetic Ketoacidosis in Sort 1 Diabetes in Scotland: A Nationwide Retrospective Cohort Observational Examine

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Diabetes treatment. 07/08/2021: dc210689. doi: 10.2337 / dc21-0689. Online before printing.

ABSTRACT

OBJECTIVE: It is unclear whether advances in the treatment of type 1 diabetes will reduce the rate of diabetic ketoacidosis (DKA). We examined temporal trends in DKA rates in a national cohort of people with type 1 diabetes followed for 14 years, both overall and by socio-economic characteristics.

Research design and methods: All individuals with type 1 diabetes in Scotland who were alive between January 1, 2004 and December 31, 2018 and were at least 1 year old were identified using the national registry (N = 37,939). DKA deaths and hospital admissions were identified by linking to Scottish national death and morbidity records. Bayesian regression was used to test DKA time trends and the association with risk markers, including socio-economic deprivation.

RESULTS: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. The DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1,058 [95% credibility interval 1.054-1.061]). Men had lower rates than women (male to female IRR 0.814 [0.776-0.855]). DKA incidence increased in all age groups except 10-19 year olds, for whom rates were highest, but fell over the course of the study. There was a large socioeconomic gap (IRR least to most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Using insulin pumps or completing structured education were associated with lower DKA rates, and prescribing antidepressants and methadone were associated with higher DKA rates.

Conclusions: The incidence of DKA has increased since 2004, except for 10 to 19 year olds. Of particular concern are the strong and widening socio-economic disparities in the DKA’s results. Efforts to prevent DKA, especially among vulnerable groups, need to be stepped up.

PMID: 34244330 | DOI: 10.2337 / dc21-0689