Diabetic ketoacidosis epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
In 2007, the incidence of diabetic ketoacidosis (DKA) was estimated to be 13 to 26 cases per 100,000 individuals worldwide. In the Unites States, the number of hospital discharges with DKA as the first-listed diagnosis increased from about 80,000 discharges in 1988 to about 140,000 in 2009. Case-fatality rate of DKA varies according to the geographic region and ranges from a low of less than 1000 per 100,000 individuals (USA and Scotland) to a high of 30,000 per 100,000 individuals (India). The prevalence of DKA varies with age and is more common in children.
Epidemiology and Demographics
Prevalence
- In the United States, the overall prevalence of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus during 2013-2014 was 3000 individuals per 100,000 patients.
Prevalence in children and adolescents
- The following table outlines the temporal variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in children and adolescents from 2002 to 2010 in the United States:[1]
| Year of study | Age group | All | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 0–4 Years | 5–9 Years | 10–14 Years | 15–19 Years | |||||||
| Prevalence per 100,000 cases | 95% CI | Prevalence per 100,000 cases | 95% CI | Prevalence per 100,000 cases | 95% CI | Prevalence per 100,000 cases | 95% CI | Prevalence per 100,000 cases | 95% CI | |
| Type 1 diabetes | ||||||||||
| 2002–2003 | 40100 | 34500–45600 | 27900 | 23800–32000 | 28900 | 25100–32800 | 22900 | 16800–29100 | 30200 | 27800–32500 |
| 2004–2005 | 36200 | 30400–41900 | 25200 | 21400–29000 | 31500 | 27800–35300 | 22400 | 16700–28200 | 29100 | 26900–31400 |
| 2008–2010 | 41100 | 36400–45800 | 29800 | 26700–32900 | 30900 | 27900–33900 | 23500 | 19400–27700 | 31100 | 29300–32900 |
| Type 2 diabetes | ||||||||||
| 2002–2003 | — | — | — | — | 14700 | 9000–20300 | 9200 | 4900–13500 | 11700 | 8200–15200 |
| 2004–2005 | — | — | — | — | 9500 | 5100–14000 | 3100 | 400–5700 | 6300 | 3700–8900 |
| 2008–2010 | — | — | — | — | 7300 | 4700–9900 | 4200 | 2200–6200 | 5700 | 4100–7400 |
Prevalence in adults
- The following table outlines the temporal variation in the prevalence of diabetic ketoacidosis (DKA) in type 1 diabetics:[2][3][3]
| Year of study | Age group | ||||
|---|---|---|---|---|---|
| 18-25 Years | 26-30 Years | 31-49 Years | 50-64 Years | >65 years | |
| Prevalence per 100,000 cases | Prevalence per 100,000 cases | Prevalence per 100,000 cases | Prevalence per 100,000 cases | Prevalence per 100,000 cases | |
| 2010-2012 | 12000 | 7000 | 5000 | 6000 | 6000 |
| 2013-2014 | 6000 | ||||
Incidence
- The annual incidence of diabetic ketoacidosis varies in different reports and is related to the geographic location.
- Worldwide, the annual incidence of diabetic ketoacidosis varies from a low of 13 persons per 100,000 persons (Denmark) to a high of 26 per 100,000 persons (Malaysia).[4][5]
- In the Unites States, the number of hospital discharges with DKA as the first-listed diagnosis increased from about 80,000 discharges in 1988 to about 140,000 in 2009.[6]
Case-fatality rate
- Case-fatality rate of DKA varies from a low of less than 1000 per 100,000 individuals (USA and Scotland) to a high of 30,000 per 100,000 individuals (India).[7]
- Case-fatality rates of DKA differ according to the level of care provided and healthcare setting.[3]
- DKA is the most common cause of death in children and adolescents with type 1 diabetes and accounts for half of all deaths in diabetic patients younger than 24 years of age.[3][8]
Age
- The prevalence of DKA decreases with increasing age.[9]
- In children and adolescents with type 1 diabetes, DKA is the most common cause of death.
- In adult patients, DKA has an overall mortality is <1%.[10]
- In the elderly and in patients with concomitant life-threatening illnesses, the mortality rate is greater than 5%.[11]
- DKA and severe DKA at the time of type 1 diabetes diagnosis have been known to be more common among religious ultra-orthodox than among secular Jewish children, indicating that patient education and awareness of symptoms plays an important role in affecting incidence and prevalence.[12]
Gender
- The prevalence and incidence of DKA is higher in men as compared to women.[9]
Race
- The prevalence and incidence of DKA is higher in non-caucasians than caucasians.[9]
Geographical distribution
- There is marked variability in the incidence of DKA in different parts of the world.
- The frequency of DKA at the time of diagnosis of type 1 diabetes varies across different countries, for example, in United Arab Emirates where it has been reported to be 80% and in Sweden it is 12.8%.[5][13]
- In Canada and Europe, hospitalization rates for DKA in established and new patients with type 1 diabetes mellitus is 10 per 100 000 children.[14]
References
- ↑ Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, Saydah S, Imperatore G, D'Agostino RB, Mayer-Davis EJ, Pihoker C (2014). "Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study". Pediatrics. 133 (4): e938–45. doi:10.1542/peds.2013-2795. PMC 4074618. PMID 24685959.
- ↑ Beck RW, Tamborlane WV, Bergenstal RM, Miller KM, DuBose SN, Hall CA (2012). "The T1D Exchange clinic registry". J. Clin. Endocrinol. Metab. 97 (12): 4383–9. doi:10.1210/jc.2012-1561. PMID 22996145.
- ↑ 3.0 3.1 3.2 3.3 "Diabetes Care".
- ↑ Henriksen OM, Røder ME, Prahl JB, Svendsen OL (2007). "Diabetic ketoacidosis in Denmark Incidence and mortality estimated from public health registries". Diabetes Res. Clin. Pract. 76 (1): 51–6. doi:10.1016/j.diabres.2006.07.024. PMID 16959363.
- ↑ 5.0 5.1 Craig ME, Jones TW, Silink M, Ping YJ (2007). "Diabetes care, glycemic control, and complications in children with type 1 diabetes from Asia and the Western Pacific Region". J. Diabetes Complicat. 21 (5): 280–7. doi:10.1016/j.jdiacomp.2006.04.005. PMID 17825751.
- ↑ "NHDS - National Hospital Discharge Survey Homepage".
- ↑ "Risk of death following admission to a UK hospital with diabetic ketoacidosis | SpringerLink".
- ↑ "DIABETIC KETOACIDOSIS IN CHILDREN - ScienceDirect".
- ↑ 9.0 9.1 9.2 Farsani SF, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA (2017). "Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review". BMJ Open. 7 (7): e016587. doi:10.1136/bmjopen-2017-016587. PMID 28765134.
- ↑ "NHDS - National Hospital Discharge Survey Homepage".
- ↑ Malone ML, Gennis V, Goodwin JS (1992). "Characteristics of diabetic ketoacidosis in older versus younger adults". J Am Geriatr Soc. 40 (11): 1100–4. PMID 1401693.
- ↑ Gruber N, Reichman B, Lerner-Geva L, Pinhas-Hamiel O (2015). "Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children". Acta Diabetol. 52 (2): 365–71. doi:10.1007/s00592-014-0653-4. PMID 25267080.
- ↑ Samuelsson U, Stenhammar L (2005). "Clinical characteristics at onset of Type 1 diabetes in children diagnosed between 1977 and 2001 in the south-east region of Sweden". Diabetes Res. Clin. Pract. 68 (1): 49–55. doi:10.1016/j.diabres.2004.08.002. PMID 15811565.
- ↑ "care.diabetesjournals.org" (PDF).