Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control

OBJECTIVE This study tested the hypothesis that diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control independently of established risk factors. RESEARCH DESIGN AND METHODS This was a prospective cohort study of 3,364 Colorado residents diagnosed with type 1 diabetes before 18 years of age, in 1998–2012, and monitored for up to 15 years. Of those, 1,297 (39%) had DKA at diagnosis (blood glucose >250 mg/dL, and venous pH 1c levels were measured an average of 2.8 times/year (median 20 HbA 1c values/patient). A linear mixed model was used to examine the effect of DKA on long-term HbA 1c levels, adjusting for age, race/ethnicity, sex, family history of diabetes, health insurance, and insulin pump use. RESULTS DKA at diagnosis predicted persistently elevated HbA 1c levels. Compared with children without DKA, HbA 1c tracked 1.4% (15.3 mmol/mol) higher in those with severe DKA ( P P 1c by 0.5% (5.5 mmol/mol; P P 1c by, respectively, 0.4% (4.4 mmol/mol; P P = 0.01). CONCLUSIONS DKA at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control, independent of demographic and socioeconomic factors.