Risk factors for diabetic ketoacidosis at first presentation of type 1 diabetes: an 8-year (2015-2022) audit at an Australian regional hospital.

Abstract

Background: Risk factors for diabetic ketoacidosis (DKA) at first presentation of type 1 diabetes (T1DM) have been investigated in a small number of studies, but further studies are required to better define them. In particular, a family history of T1DM was shown to be protective, while the effect of pancreatic autoimmunity is uncertain.

Aims: This retrospective study, performed at Townsville University Hospital, aimed to study whether the incidence of DKA at first presentation of T1DM was associated with (i) a family history of T1DM and (ii) the number and titre of pancreatic autoantibodies. This study was the first of its kind covering both adult and paediatric cohorts in regional Queensland, Australia.

Methods: Patients diagnosed with T1DM between January 2015 and December 2022 were included. Medical and patient data were retrospectively collected and analysed using spss.

Results: A total of 146 patients met the inclusion criteria. Seventy-eight (53.4%) patients presented with DKA, whereas 68 (46.6%) did not. Among patients with at least one relative with T1DM, 19 (36.5%) patients had DKA and 33 (63.5%) did not (odds ratio (OR): 0.35, confidence interval (CI): 0.17-0.72, P = 0.004). Among those with a first-degree relative with T1DM, four (18.2%) patients had DKA and 18 (81.8%) did not (OR: 0.16, CI: 0.05-0.49, P < 0.001). There was no significant difference in DKA incidence at diagnosis with status or titre of antibodies.

Conclusions: Family history was protective against DKA at first presentation of T1DM, whereas there was no relationship with the presence or titre of pancreatic autoantibodies.