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Consistently high incidence of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes

To the Editor: Data from the tertiary paediatric hospitals in Brisbane (Royal Children’s and Mater Children’s Hospitals) support Claessen and colleagues’ letter.1

A total of 1091 children aged < 18 years were initially admitted from 1 January 2001 to 31 December 2011 with a new diagnosis of type 1 diabetes (T1D) (Box). Diabetic ketoacidosis (DKA) was defined as venous pH < 7.3 or serum bicarbonate level < 15 mmol/L in association with hyperglycaemia and ketoacidosis. Severity was defined as mild (pH 7.2 to < 7.3, or serum bicarbonate level 10 mmol/L to < 15 mmol/L), moderate (pH 7.1 to < 7.2, or serum bicarbonate 5 mmol/L to < 10 mmol/L) and severe (pH < 7.1, or serum bicarbonate < 5 mmol/L). Overall, 348 of 1091 children (31.9%; 95% CI, 29.1%–34.7%) presented with DKA over the 11 years studied. Initial analysis of trend suggested that the proportion of DKA was increasing over the period (χ2 test for trend, P = 0.005). However, when the 119 children whose DKA status was not recorded were excluded,…