Lightning Talk + Poster ESA-SRB-ANZOS 2025 in conjunction with ENSA

What are the risk factors for diabetic ketoacidosis at first presentation of type 1 diabetes?: an eight-year (2015-2022) audit at an Australian regional hospital (129002)

David D Je 1 , Amogh Bhardwaj 2 , Zhi Yi Lim 2 , Venkat N Vangaveti 1 2 , Usman H Malabu 1 2 , Yong Mong Tan 1 2
  1. Department of Endocrinology and Diabetes, Townsville University Hospital, Townsville, Queensland, Australia
  2. College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

Background: Few studies have studied risk factors of diabetic ketoacidosis (DKA) at first presentation of type 1 diabetes (T1DM), with inconsistent findings requiring further studies. Family history of T1DM was protective, whilst the effect of pancreatic autoimmunity is uncertain.

Aims: This retrospective study was conducted at Townsville University Hospital to determine whether incidence of DKA at first presentation of T1DM was associated with a) family history of T1DM, b) number or titre of pancreatic autoantibodies.

Method: All patients diagnosed with T1DM between January 2015 and December 2022 were included. Medical data were retrospectively collected, and analysed using SPSS.

Results: 146 patients were studied. Median age was 13 years. 64 patients (43.8%) were female. 78 (53.4%) patients presented with DKA. Median HbA1c for DKA-patients was higher (12.90%) compared to non-DKA-patients (10.80%) (P < 0.001). Among patients with at least 1 relative with T1DM, 19 (36.5%) had DKA (OR: 0.35, CI: 0.17-0.72, P = 0.004). Among those with 1st degree relative with T1DM, 4 (18.2%) had DKA (OR: 0.16, CI: 0.05-0.49, P <0.001). There was no significant difference in DKA risk with number or titre of antibodies.

Conclusion: Our study found that having a first degree relative with T1DM was protective against DKA at first presentation of T1DM. This may be from increased awareness of diabetes symptoms and readily available glucose test kits in the family. Higher HbA1c seen in DKA presentations may reflect longer duration of undiagnosed hyperglycaemia which may relate to familial and health provider awareness of diabetes. Pancreatic autoantibodies were non-contributory. Our study was the first of its kind covering both adult and paediatric cohorts in regional Queensland, Australia.