Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In children with type 1 diabetes, diabetic ketoacidosis is not associated with poor long-term metabolic control.

Evidence Rating Level: 2 (Good)

Diabetic ketoacidosis (DKA), although often preventable, is the most common complication of newly diagnosed type 1 diabetes (T1D). Some studies have demonstrated that DKA present at time of diagnosis is associated with longer hospitalization and higher insulin requirements. Therefore, this retrospective cohort study aimed to evaluate whether children with T1D who had DKA have worse glycemic control compared to those who do not. The study matched 85 participants with T1D who had DKA at onset of the disease to 85 participants without DKA at diagnosis in a one-to-one ratio. The mean age at diagnosis for participants with DKA was 7.93 years and the pH on recognition was 7.19 compared to the group without DKA that had a mean age of 7.63 years and pH of 7.39. The study defined different degrees of acidosis as mild, moderate, and severe (pH < 7.3, < 7.2, < 7.1, respectively). The primary outcome measured was the comparison of HbA1c between the group with DKA and without DKA. It was found that HbA1c at onset of diabetes was statistically higher in children with DKA (p < 0.001) with maximum values reported in children with severe DKA (HbA1c = 13.25%). The study found a sharp decline in the HbA1c levels after the first year following diagnosis in both groups. Thereafter, the HbA1c levels remained relatively stable throughout the 5-year follow-up period. There were no statistically significant differences found in the HbA1c levels when comparing those who had DKA and those who did not (HbA1c (%) at 1 year, 7.10 vs. 6.80, p = 0.233; HbA1c (%) at 2 years, 7.00 vs. 7.10, p = 0.676; HbA1c (%) at 3 years, 7.20 vs. 7.20, p = 0.522; HbA1c (%) at 4 years, 7.40 vs. 7.30, p = 0.983; HbA1c (%) at 5 year, 7.20 vs 7.30, p = 0.413). The secondary outcomes measured were total daily dose of insulin (TDD), basal rate, and body-mass index. There were no statistically significant differences found in these outcomes between the two groups. Therefore, the study concluded that the presence of DKA at diabetes diagnosis is not associated with poor long-term outcomes. Although this study answers an important clinical question, larger-scale studies that account for confounding factors such as socioeconomics are needed to support this conclusion.

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