Große Johann, Hornstein Henriette, Manuwald Ulf, Kugler Joachim, Glauche Ingmar, Rothe Ulrike
Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Health Sciences/Public Health, Dresden.
Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry (IMB), Dresden.
Horm Metab Res. 2018 Mar;50(3):209-222. doi: 10.1055/s-0044-102090. Epub 2018 Mar 9.
Type 1 diabetes mellitus (T1DM) is usually diagnosed by insulin deficiency at a young age. Diabetic ketoacidosis (DKA) represents a severe complication occurring before the first diagnosis of T1DM. Actually, the data situation is still unsettled in assessing the current state of diagnosis. This study summarizes the latest rates of DKA of new-onset T1DM in children and adolescents in different countries available over the last five years. Different T1DM-related, geographical and socioeconomic moderators are suitable to explain the heterogeneity of observed DKA rates. A systematic literature search using PubMed, EMBASE*, and MedLine* (*via OVID) was conducted to extract worldwide DKA rates covering publications from April 2011 to May 2016. We define DKA consistently by pH<7.3 or bicarbonate<15 mmol/l. We identified 34 suitable studies covering DKA rates in 25 countries. Overall DKA rates were compared to earlier studies to identify a temporal trend. We further applied a random effects meta-analysis and used meta-regression to reveal moderators of DKA rate heterogeneity. This review evaluating 34 studies includes 47 000 children and adolescents in total. DKA rates varied from 14.7% (Denmark) to 79.8% (Saudi Arabia). DKA rates are still high but a decline can also be recognized. The meta-regression shows that latitude (p<0.000) and human development index (HDI) (p<0.000) are moderators of DKA rates. The frequency of DKA rates occurrence varies widely for different countries. Both latitude and HDI partially explain the observed heterogeneity, while other moderators such as density of physicians showed no obvious correlation.
1型糖尿病（T1DM）通常在年轻时因胰岛素缺乏而被诊断出来。糖尿病酮症酸中毒（DKA）是T1DM首次诊断之前发生的一种严重并发症。实际上，在评估当前诊断状况时，数据情况仍未确定。本研究总结了过去五年中不同国家儿童和青少年新发T1DM的DKA最新发生率。不同的与T1DM相关、地理和社会经济调节因素适合解释观察到的DKA发生率的异质性。通过使用PubMed、EMBASE和MedLine（通过OVID）进行系统的文献检索，以提取涵盖2011年4月至2016年5月出版物的全球DKA发生率。我们将DKA统一定义为pH<7.3或碳酸氢盐<15 mmol/L。我们确定了34项合适的研究，涵盖了25个国家的DKA发生率。将总体DKA发生率与早期研究进行比较，以确定时间趋势。我们进一步应用随机效应荟萃分析，并使用荟萃回归来揭示DKA发生率异质性的调节因素。这项评估34项研究的综述总共包括47000名儿童和青少年。DKA发生率从14.7%（丹麦）到79.8%（沙特阿拉伯）不等。DKA发生率仍然很高，但也可以看出有所下降。荟萃回归表明，纬度（p<0.000）和人类发展指数（HDI）（p<0.000）是DKA发生率的调节因素。不同国家DKA发生率的出现频率差异很大。纬度和HDI都部分解释了观察到的异质性，而其他调节因素如医生密度则没有明显的相关性。
