Researchers have shown that young children being monitored from birth in a long-term research study have a reduced risk of developing diabetic ketoacidosis (DKA) at onset of type 1 diabetes compared to children in the general population. DKA is caused by profound insulin deficiency. When symptoms of diabetes are not recognized, the disease can progress to life-threatening DKA. Scientists estimate that as many as 40 percent of children who develop type 1 diabetes under age 3 and 60 percent of children under age 2 have DKA at disease onset. This condition could lead to coma or death, underscoring the need to find ways to prevent it. Toward that goal, researchers examined whether children participating in The Environmental Determinants of Diabetes in the Young (TEDDY) study had reduced rates of DKA. TEDDY is following over 8,000 newborns at high genetic risk of developing type 1 diabetes until they are 15 years old to identify environmental triggers of disease. Researchers hypothesized that children in TEDDY may have lower rates of DKA at disease onset because they are being monitored frequently and the parents know that their child is at genetic risk of developing type 1 diabetes, both of which could lead to earlier diagnosis and prevention of DKA.
To determine whether participants in TEDDY have lower rates of DKA, researchers compared children who were diagnosed with the disease in TEDDY with children who were diagnosed in the general population of countries where TEDDY is being conducted (United States, Germany, Finland, Sweden), using data from studies and national registries. In children diagnosed under age two, the percent with DKA was significantly lower in TEDDY than in the general population. In children diagnosed under age five, the percent with DKA was lower in TEDDY compared to the general populations in the United States and Germany, but not different in Finland and Sweden, where the disease is more common. The research suggests that DKA occurs less frequently in TEDDY children. The scientists note that it is currently cost-prohibitive to do the type of screening and monitoring being done in TEDDY on a population-wide scale. However, the research sheds light on approaches that could be used in the future to achieve the goal of preventing this life threatening condition.
Elding-Larsson H, Vehik K, Bell R, et al. Reduced prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in young children participating in longitudinal follow-up. Diabetes Care 34: 2347-2352, 2011.