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The burden of Autoimmune T1D

DKA IS A MEDICAL EMERGENCY ASSOCIATED WITH HIGH MORBIDITY3

Prevalence of DKA at diagnosis varies, but can be up to 70% across Europe and North America. DKA at diagnosis is often due to diagnostic error and treatment delay.3

DKA is responsible for approximately half of all hospitalisations in people with autoimmune T1D.29,30
DKA can have serious neurocognitive effects31; even a single severe episode has been shown to impair memory and IQ.*32
DKA is associated with a sustained negative effect on glycaemic control over time,† increasing morbidity and mortality.33

By approximately how much can screening and monitoring programmes reduce DKA rates?

DKA, diabetic ketoacidosis; FLUID, Fluid Therapies Under Investigation in Diabetic Ketoacidosis; IQ, intelligence quotient; PECARN, Pediatric Emergency Care Applied Research Network; T1D, type 1 diabetes.
*In a prospective study including 758 children who presented with DKA in a randomised multisite clinical trial evaluating fluid protocols for DKA treatment (PECARN FLUID trial). DKA status was associated with lower scores in overall IQ, memory for item-colour associations and forward digit span recall.32 †Independent of other variables.33

AVOIDING DKA AT DIAGNOSIS CAN IMPROVE HEALTH OUTCOMES1,41–44

Screening can facilitate prompt and effective glycaemic management, reducing the risk of severe macrovascular and microvascular complications.1,41–44

Avoiding DKA at diagnosis is associated with better long-term HbA1c levels.7,33

Preventing chronic hyperglycaemia can help reduce the risk of:


MACROVASCULAR COMPLICATIONS45

including stroke and cardiovascular disease
 


MICROVASCULAR COMPLICATIONS45

including eye, kidney and nervous system
 


A REDUCED LIFE EXPECTANCY*†46

An average of up to ~18 life-years lost in those diagnosed before age 10

Of ~40% of adults with autoimmune T1D initially misdiagnosed, 77% were misdiagnosed with T2D‡; this can delay proper insulin replacement therapy, prolong hyperglycaemia and increase the risk of DKA.20

CI, confidence interval; DKA, diabetic ketoacidosis; HbA1c, haemoglobin A1c; T1D, type 1 diabetes; US, United States.
*Compared to matched controls, according to a nationwide, register-based cohort study including 27,195 individuals with autoimmune T1D in Sweden, using data from the Swedish National Diabetes Register46 †Men diagnosed with autoimmune T1D before 10 years of age lost a median of 14.2 life-years (95% CI 12.1, 18.2). Females diagnosed at the same age lost a median of 17.7 life-years (95% CI 14.5, 20.4). People diagnosed after 20 years of age lost approximately 10 life-years.46 ‡In a retrospective online survey of people with autoimmune T1D and caregivers of people with autoimmune T1D in the US, a diagnosis of autoimmune T1D was missed in 38.6% of those diagnosed at ≥18 years of age. Of those people, 76.8% were initially diagnosed with type 2 diabetes.20

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