Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients |
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| Affiliation: | 1. From the The Warren Alpert Medical School of Brown University, Providence, Rhode Island;2. Department of Internal Medicine and Pediatrics, Rhode Island Hospital, Providence, Rhode Island;3. Division of Pediatric Endocrinology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts;4. Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island;5. Division of Pediatric Endocrinology, Hasbro Children''s Hospital, Providence, Rhode Island.;1. From the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Ohio.;2. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Ohio.;3. Cleveland Clinic Section of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Ohio.;4. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.;1. From Memorial Healthcare System, Hollywood, Florida;2. Loyola University Medical Center, Maywood, Illinois;3. New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York;4. Massachusetts General Hospital, Boston, Massachusetts.;1. From Metabolic Bone Diseases Service, Endocrine Institute, Meir Medical Center, Kfar Saba, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Department of Medical Management, Meir Medical Center, Kfar Saba, Israel;4. Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel;5. Department of Geriatrics, Meir Medical Center, Kfar Saba, Israel;6. Dorot Medical Center for Rehabilitation and Geriatrics, Netanya, Israel;7. Clalit Health Services, Tel Aviv, Israel. |
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| Abstract: | Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM).Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM.Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household.Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence.Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus |
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