Type 1 diabetes (T1D) is a disease affecting persons of all ages. T1D is an autoimmune condition (where the body attacks itself) leading to a lifelong dependency on a medication called Insulin. Unfortunately, one in four children who have T1D are found to have it when they attend hospital with a complication called diabetic ketoacidosis (DKA). DKA is a life-threatening complication where the body doesn't have the right amount of sugar it needs and starts searching for other sources of fuel. However, we don't currently know of the people who develop T1D in adulthood, whether they also come to the hospital with this complication.
Hence, we will use GP records and hospital data to see how frequently DKA occurs at the point of diagnosis for adult-onset T1D. If we can see who is affected and when, it can help us plan services to try and support these patients earlier so they don't have to come to hospital with such a severe complication.
Linked to this, using the same data, we also plan to see if we can find out the risk factors for attending hospital with DKA at the point of their T1D diagnosis. Lastly, we also want to see how their future health is if they have been diagnosed as such with DKA and T1D compared to people who did not develop T1D in this way. Undertaking these analyses will help us understand more about this condition and support these patients better.
Type 1 diabetes (T1D) is an autoimmune condition leading to insulin dependency. T1D incidence is equivalent throughout the first six decades. In the UK, 25% of children present as an emergency in diabetic ketoacidosis (DKA). DKA is associated with a 0.15-0.3% mortality. Short and long-term sequelae of DKA, include neurocognitive changes in the proceeding 6-12 months and poorer glucose control. In children, predisposing factors for DKA include deprivation, ethnic minority background and higher HbA1c at diagnosis.
The incidence of DKA in adults newly diagnosed with T1D and predisposing factors remain unclear. A UK biobank study reported similar rates of DKA in individuals newly diagnosed with T1D aged under 30 years (9%), compared to 11% in 31-60 year olds. However, T1D diagnosis in adults over 30 years is challenging due to higher prevalence of type 2 diabetes (T2D). This diagnostic uncertainty likely contributes to the paucity of data on incidence of DKA at onset of T1D in adults.
We are planning to undertake a comprehensive exploration of the epidemiology of DKA at disease onset in adults with T1D using the CPRD GOLD, AURUM and linked HES datasets from 1st Jan 2001-latest data available. We will undertake a case-control study comparing adults with DKA at diagnosis (cases) against those without (control). We will use logistic regression to identify the odds-ratio of pre-determined risk factors (exposures). Following this, using a retrospective cohort study design, we will examine the risk of patients with DKA (exposed) at diagnosis developing subsequent illnesses compared to those without DKA (unexposed). We will examine risk of microvascular complications and macrovascular complications.
Benefits: 1) Describing the burden of DKA in adult-onset T1D will help with healthcare service planning and provide opportunities to reduce inequalities, and 2) Increased knowledge of subsequent morbidity will provide opportunities to tailor preventative advice and therapy.
Objective 1: DKA rates in adults newly diagnosed with T1D
• Proportion of adults presenting with DKA at onset of T1D.
Objective 2: Risk factors for DKA (see appendix 1 for full list)
• The risk factors of interest are: age, smoking, obesity, ethnicity, gender, socio-economic deprivation, comorbidities.
• Time to diagnosis of T1D from first key symptom: osmotic symptoms (polyuria, polydipsia)
Objective 3: Outcomes of DKA
• Neuropathy, retinopathy, nephropathy, cardiovascular and stroke outcomes and mortality
Joht Singh Chandan - Chief Investigator - University of Birmingham
Joht Singh Chandan - Corresponding Applicant - University of Birmingham
Jonathan Hazlehurst - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Lauren Quinn - Collaborator - University of Birmingham
Nicola Adderley - Collaborator - University of Birmingham
Punith Kempegowda - Collaborator - University of Birmingham
Lauren Quinn - Collaborator - University Hospitals Of Leicester
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation