TY - JOUR
T1 - Rising Rates And Widening Socio-economic Disparities In Diabetic Ketoacidosis In Type 1 Diabetes In Scotland
T2 - A Nationwide Retrospective Cohort Observational Study
AU - O’Reilly, Joseph E.
AU - Jeyam, Anita
AU - Caparrotta, Thomas M.
AU - Mellor, Joseph
AU - Höhn, Andreas
AU - McKeigue, Paul M.
AU - McGurnaghan, Stuart J.
AU - Blackbourn, Luke A. K.
AU - McCrimmon, Rory
AU - Wild, Sarah H.
AU - Petrie, John R.
AU - McKnight, John A.
AU - Kennon, Brian
AU - Chalmers, John
AU - Phillip, Sam
AU - Leese, Graham
AU - Lindsay, Robert S.
AU - Sattar, Naveed
AU - Gibb, Fraser W
AU - Colhoun, Helen M.
AU - Scottish Diabetes Research Network Epidemiology Group
N1 - Funding: This study was supported by funding from the Diabetes UK (17/0005627)
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics.Research Design and Methods: All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation.Results: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates.Conclusions: DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
AB - Objective: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics.Research Design and Methods: All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation.Results: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates.Conclusions: DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
UR - http://www.scopus.com/inward/record.url?scp=85115449222&partnerID=8YFLogxK
U2 - 10.2337/dc21-0689
DO - 10.2337/dc21-0689
M3 - Article
C2 - 34244330
SN - 0149-5992
VL - 44
SP - 2010
EP - 2017
JO - Diabetes Care
JF - Diabetes Care
IS - 9
ER -
