Speed Poster ESA-SRB-APEG-NZSE 2022

Diabetic ketoacidosis at onset of type 1 diabetes and long-term HbA1c in 7961 children and young adults in the Australasian Diabetes Data Network (ADDN) (#75)

Helen Clapin 1 2 , Arul Earnest 3 , Peter Colman 4 5 , Elizabeth Davis 1 2 , Craig Jefferies 6 , Kym Anderson 7 , Melissa Chee 8 , Philip Bergman 3 9 , Martin de Bock 10 11 , Kung-Ting Kao 5 12 13 , P. Gerry Fegan 14 , Jane Holmes-Walker 15 , Stephanie Johnson 16 , Bruce King 17 , Meng Tuck Mok 18 , Kruthika Narayan 19 20 , Alexia Peña 21 , Richard Sinnott 5 , Ben Wheeler 22 , Anthony Zimmermann 23 , Maria Craig 19 20 , Jennifer Couper 21
  1. Perth Children's Hospital, Subiaco, WA, Australia
  2. Telethon Kids Institute, Nedlands, WA, Australia
  3. Monash University, Clayton, Vic, Australia
  4. Royal Melbourne Hospital, Parkville, Vic, Australia
  5. The University of Melbourne, Parkville, Vic, Australia
  6. Starship Children’s Health, Grafton, Auckland, New Zealand
  7. Barwon Health, Geelong, Vic, Australia
  8. JDRF Australia, St Leonards, NSW, Australia
  9. Monash Children's Hospital, Clayton, Vic, Australia
  10. Canterbury District Health Board, Christchurch, New Zealand
  11. Christchurch School of Medicine, University of Otago, New Zealand
  12. Royal Children's Hospital, Parkville, Vic, Australia
  13. Murdoch Children’s Research Institute, Parkville, Vic, Australia
  14. Fiona Stanley Hospital, Murdoch, WA, Australia
  15. Westmead Hospital, Westmead, NSW, Australia
  16. Queensland Children's Hospital, South Brisbane, Qld, Australia
  17. John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
  18. Australasian Diabetes Data Network, Melbourne, Vic, Australia
  19. The Children’s Hospital at Westmead, Westmead, NSW, Australia
  20. University of NSW, Sydney, NSW, Australia
  21. Women’s and Children’s Hospital and Robinson Research Institute University of Adelaide, North Adelaide, SA, Australia
  22. Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin , New Zealand
  23. Lyell McEwin and Modbury Hospitals, Elizabeth Vale, SA, Australia

Aims

The reported relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) and long-term glycemic control varies between studies. We aimed firstly to characterise the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly to identify other independent determinants of long-term HbA1c.

 

Methods

Participants were 7961 children and young adults diagnosed with T1D by age 30 years from 2000-2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31/12/2020. Linear mixed effect models were used to study the relationship between HbA1c and other variables.

 

Results

DKA at diagnosis was present in 2647 (33.2%) participants. Over a median 5.6 (IQR 3.2, 9.4) years follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI: 0.11, 0.28; p<0.001) compared to those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c over time than multiple daily injections (MDI) (-0.28%, 95% CI: -0.31, -0.25; p<0.001), and this relationship was more pronounced in participants with severe DKA at diagnosis. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI: 1.15, 1.59; p<0.001), as was residing in postcodes of lower socioeconomic status (most versus least disadvantaged quintile +0.43%, 95% CI: 0.34, 0.52; p<0.001).

 

Conclusion

Severe DKA at diagnosis (but not moderate or mild) was associated with a marginally higher HbA1c over follow-up of ADDN children and young adults with T1D, an effect which was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher HbA1c, and CSII with lower HbA1c, further emphasising the need for equity of access to health services and modern diabetes technology for all patients with T1D.