Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

Objective: Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort. Research design and methods: The analysis included 13487 participants in the T1D Exchange clinic registry aged 2 to <26yr with T1D 2yr. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12months. Results: Non-White race, no private health insurance, and lower household income were associated with higher frequencies of both SH and DKA (p<0.001). SH frequency was highest in children <6yr old (p=0.005), but across the age range, SH was not associated with hemoglobin A1c (HbA1c) levels after controlling for other factors (p=0.72). DKA frequency was highest in adolescents (p<0.001) and associated with higher HbA1c (p<0.001). Conclusions: Our data show that poor glycemic control increases the risk of DKA but does not protect against SH in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.