Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: Results from SEARCH (United States) and YDR (India) registries

Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among ind...

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Published in:	Pediatric diabetes Vol. 22; no. 1; pp. 40 - 46
Main Authors:	Praveen, Pradeep A., Hockett, Christine W., Ong, Toan C., Amutha, Anandakumar, Isom, Scott P., Jensen, Elizabeth T., Mohan, Viswanathan, Dabelea, Dana A., D'Agostino, Ralph B., Hamman, Richard F., Mayer‐Davis, Elizabeth J., Lawrence, Jean M., Dolan, Lawrence M., Kahn, Michael G., Madhu, Sri Venkata, Tandon, Nikhil
Format:	Journal Article
Language:	English
Published:	Former Munksgaard John Wiley & Sons A/S 01.02.2021 John Wiley & Sons, Inc
Subjects:	Adolescent Child Child, Preschool Diabetes Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 2 - diagnosis Diabetic ketoacidosis Diabetic Ketoacidosis - epidemiology Diagnosis Female Humans India - epidemiology Infant Infant, Newborn Ketoacidosis Male Medical diagnosis Registries SEARCH for Diabetes in Youth registry Terminology type 1 diabetes type 2 diabetes United States - epidemiology YDR registry Young Adult United States India United States > US type 1 diabetes SEARCH for Diabetes in Youth registry type 2 diabetes YDR registry diabetic ketoacidosis
ISSN:	1399-543X, 1399-5448, 1399-5448
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Abstract	Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. Methods We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. Results There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). Conclusions There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.
AbstractList	There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis. Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. Methods We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. Results There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). Conclusions There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis. There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries.BACKGROUNDThere is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries.We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH.METHODSWe harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH.There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4).RESULTSThere were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4).There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.CONCLUSIONSThere is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis. Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. Methods We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. Results There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). Conclusions There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.
Author	Kahn, Michael G. Isom, Scott P. D'Agostino, Ralph B. Amutha, Anandakumar Mohan, Viswanathan Ong, Toan C. Dabelea, Dana A. Madhu, Sri Venkata Dolan, Lawrence M. Tandon, Nikhil Lawrence, Jean M. Mayer‐Davis, Elizabeth J. Praveen, Pradeep A. Hockett, Christine W. Hamman, Richard F. Jensen, Elizabeth T.
AuthorAffiliation	5 Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC 6 Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC 3 Department of Pediatrics, University of Colorado, Aurora, CO 2 Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 10 University College of Medical Science, GTB Hospital, Delhi, India 8 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 4 Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India 1 Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India 7 Department of Nutrition, University of North Carolina, Chapel Hill, NC 9 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
AuthorAffiliation_xml	– name: 9 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH – name: 2 Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO – name: 3 Department of Pediatrics, University of Colorado, Aurora, CO – name: 6 Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC – name: 5 Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC – name: 8 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA – name: 1 Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India – name: 4 Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India – name: 10 University College of Medical Science, GTB Hospital, Delhi, India – name: 7 Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Copyright	2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Copyright John Wiley & Sons, Inc. 2021
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Keywords	type 1 diabetes SEARCH for Diabetes in Youth registry type 2 diabetes YDR registry diabetic ketoacidosis
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Notes	Funding information Wake Forest University School of Medicine, Grant/Award Numbers: 200‐2010‐35171, U01 DP000250, U48/CCU919219, U18DP006131; Seattle Children's Hospital, Grant/Award Numbers: U18DP002710‐01, U01 DP000244, U58/CCU019235‐4, U18DP006136; University of North Carolina at Chapel Hill, Grant/Award Numbers: U18DP002708, U01 DP000254, U48/CCU419249, U18DP006138; Cincinnati's Children's Hospital Medical Center, Grant/Award Numbers: 1U18DP002709, U01 DP000248, U48/CCU519239, U18DP006134; University of Colorado Denver, Grant/Award Numbers: U18DP000247‐06A1, U01 DP000247, U48/CCU819241‐3, U18DP006139; Kaiser Permanente Southern California, Grant/Award Numbers: U18DP002714, U01 DP000246, U48/CCU919219, U18DP006133; Centers for Disease Control and Prevention, Grant/Award Numbers: U18DP006139, U18DP006138, U18DP006136, U18DP006134, U18DP006133, 1U18DP006131, DP‐10‐001, DP‐05‐069, 00097; National Institute of Diabetes and Digestive and Kidney Diseases; Ohio Department of Health; University of Cincinnati, NIH/NCATS, Grant/Award Numbers: UL1 TR001425, UL1 TR000077; University of Colorado at Denver, Grant/Award Number: P30 DK57516; University of Colorado Pediatric Clinical and Translational Research Center, NIH/NCATS, Grant/Award Number: UL1 TR000154; Seattle Children's Hospital and the University of Washington, NIH/NCATS, Grant/Award Number: UL1 TR00423; Medical University of South Carolina, NIH/National Center for Advancing Translational Sciences (NCATS), Grant/Award Numbers: UL1 Tr001450, UL1 TR000062; Southern California Permanente Medical Group; Kaiser Foundation Health Plan; Indian Council of Medical Research; National Institutes of Health, Grant/Award Number: R21DK105869‐02 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Author contributions: N.T, D.D, V.M, R.F.H and E.J.M.-D conceptualized the study and oversaw the data harmonization. T.C.O, M.G.K, C.W.H, S.P.I., A.A and P.P harmonized and transformed data into the common data model (OMOP). S.P.I., C.W.H and T.C.O conducted data analysis. P.P and N.T prepared the first draft of the manuscript and provided oversight for study analyses. S.V.M contributed to data collection. All authors reviewed and edited the manuscript and contributed to discussion. All authors have read and approved the final manuscript.
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Snippet	Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However,... There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for... Background There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However,...
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SubjectTerms	Adolescent Child Child, Preschool Diabetes Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 2 - diagnosis Diabetic ketoacidosis Diabetic Ketoacidosis - epidemiology Diagnosis Female Humans India - epidemiology Infant Infant, Newborn Ketoacidosis Male Medical diagnosis Registries SEARCH for Diabetes in Youth registry Terminology type 1 diabetes type 2 diabetes United States - epidemiology YDR registry Young Adult
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Title	Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: Results from SEARCH (United States) and YDR (India) registries
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