Diabetic ketoacidosis at the onset of type 1 diabetes

Despite major advances in the care of diabetes, diabetic ketoacidosis remains a leading cause of morbidity, mortality, and hospital admission in children and adolescents with type 1 diabetes.1 Deaths are mainly caused by cerebral oedema, which is more common in patients who are younger, have new onset diabetes, or have a longer duration of symptoms.1 2 Other possible causes of morbidity and mortality associated with diabetic ketoacidosis include hypokalaemia, pulmonary oedema, cerebral thrombosis or infarction, and rhabdomyolysis.1 2 3 Given these life threatening complications and the healthcare costs associated with hospital admission, prevention of diabetic ketoacidosis should be the primary goal for clinicians.

In the linked systematic review (doi:10.1136/bmj.d4092), Usher-Smith and colleagues looked at 46 studies of more than 24 000 children from 31 countries to identify factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and adolescents.4 The studies span the late 1980s to 2008. The authors …