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[Incidence and related risk factors of diabetic ketoacidosis in Guangdong type 1 diabetics].

OBJECTIVE
To determine the incidence and the predictors of diabetes ketoacidosis (DKA) in Chinese type 1 diabetics so as to lay a foundation for better prevention and treatment.


METHODS
For this cross-sectional study, a total of 611 patients with established type 1 diabetes between August 6, 2010 and March 31, 2012 were recruited from 16 hospitals in Guangdong Province. And 491 of them were over 18 years old. A data entry form was used to collect the patient information on demographics, medical history, acute/chronic complications, smoking/drinking status, diet, exercise, physical examination and treatment, etc. Hemoglobin A1c (HbA1c) and stimulated C peptide levels were centrally measured. The incidence rate of diabetic ketoacidosis (DKA) was calculated at events per 100 patient-years. To determine the predictors of DKA, Poisson's regression model was used for analysis. And backward stepwise logistic regression analysis was performed to identify the predictors of DKA recurrence. The protocol and informed consent form were approved by Ethics Committee of Third Affiliated Hospital, Sun Yat-sen University. Written informed consent was obtained from patients (age > 18 years) or their legal guardians (age < 18 years).


RESULTS
Among them, 53.7% were females. The mean age was 27.8 years (range: 19.5 - 37.3). The age of onset was 22.7 (14.0 - 31.4) years old and disease duration 4.3 (1.7 - 7.9) years. Overweight and obese patients accounted for 10.8% and 1.0% respectively. Among them, the self-monitoring frequency of blood glucose was 0.4 (0.1 - 1.4) times per day. Overall, 26.4% patients reached the target of age-specific HbA1c values. The overall incidence of DKA was 26.4 per 100 patient-years. Significant predictors of DKA in the Poisson regression model were females (RR = 2.12), medical insurance claiming percentage below 50% (RR = 1.84), uncontrolled diet (never controlled diet vs. usually controlled diet, RR = 1.76), smoking (RR = 2.18) as well as worse glycemic control (HbA1c per 1.0% increment, RR = 1.15). Totally, 34.4% of DKA episodes occurred in 3.8% of type 1 diabetics with recurrent events (no less than 2 episodes). The recurrence of DKA was associated with females (RR = 10.56), smoking (RR = 6.99), worse beta cell function (stimulated C peptide per 100 pmol/L decrement, RR = 4.88) and worse glycemic control (HbA1c per 1.0% increment, RR = 1.16).


CONCLUSION
There is a high incidence of DKA in Chinese type 1 diabetics. And it is recurrent in high-risk patients. Comprehensive management should be offered to control modifiable risk factors in these patients.