Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: Evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014

Background There has been little change in the incidence of diabetic ketoacidosis ( DKA ) in newly diagnosed type 1 diabetes mellitus ( T1DM ) in children and adolescents in most developed countries. Objectives To assess potentially modifiable antecedents of DKA in children <15 years of age with new onset T1DM . Methods Retrospective review of prospectively collected data from a complete regional cohort of children with T1DM in Auckland (New Zealand) from 2010 to 2014. DKA and severity were defined according to the ISPAD 2014 guidelines. Results A total of 263 children presented with new onset T1DM during the 5‐year study period at 9.0 years of age (range 1.0‐14.7), of whom 61% were NZ ‐European, 14% Maori, 13% Pacifica, and 11% other. A total of 71 patients (27%) were in DKA , including 31 mild, 20 moderate, and 20 severe DKA . DKA was associated with no family history of T1DM , higher glycated hemoglobin ( HbA1c ) values at presentation, self‐presenting to secondary care, health care professional contacts in the 4 weeks before final presentation, and greater deprivation. Although a delay in referral from primary care for laboratory testing was common (81/216), only delay for more than 48 hours was associated with increased risk of DKA (11/22 > 48 h vs 12/59 referred at <48 h, P  = .013). Conclusions These data suggest that in addition to lack of family awareness potentially modifiable risk factors for new onset DKA include prolonged delay for laboratory testing and a low index of medical suspicion for T1DM leading to delayed diagnosis.