Lower Prevalence of Diabetic Ketoacidosis at Diagnosis in Research Participants Monitored for Hyperglycemia

Context: In Colorado children, the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes has been increasing over time. Objective To evaluate the prevalence of and factors involved in DKA at type 1 diabetes diagnosis among participants followed in monitoring research studies before diagnosis compared to patients from the community. Methods: We studied patients < 18 years diagnosed with type 1 diabetes between 2005 and 2021 at the Barbara Davis Center for Diabetes and compared the prevalence of and factors associated with DKA at diagnosis among participants in preclinical monitoring studies vs those diagnosed in the community. Results: Of 5049 subjects, 164 were active study participants, 42 inactive study participants, and 4843 were community patients. Active study participants, compared to community patients, had lower HbA1c (7.3% vs 11.9%; P < .001) and less frequently experienced DKA (4.9% vs 48.5%; P < .001), including severe DKA (1.2% vs 16.2%; P < .001). Inactive study participants had intermediate levels for both prevalence and severity of DKA. DKA prevalence increased in community patients, from 44.0% to 55%, with less evidence for a temporal trend in study participants. DKA prevalence was highest in children < 2 years (13% in active study participants vs 83% in community patients). In community patients, younger age (P = .0038), public insurance (P < .0001), rural residence (P < .0076), higher HbA1c (P < .0001), and ethnicity minority status (P < .0001) were associated with DKA at diagnosis. Conclusion: While DKA prevalence increases in community patients over time, it stayed < 5% in active research participants, who have a 10 times lower prevalence of DKA at diagnosis, including among minorities.