Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review.

OBJECTIVE: To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults. DESIGN: Systematic review. DATA SOURCES: PubMed, EMBASE, Web of Science, Scopus, and Cinahl and article reference lists. STUDY SELECTION: Cohort studies including unselected groups of children and young adults presenting with new onset type 1 diabetes that distinguished between those who presented in diabetic ketoacidosis and those who did not and included a measurement of either pH or bicarbonate in the definition of diabetic ketoacidosis. There were no restrictions on language of publication. RESULTS: 46 studies involving more than 24,000 children in 31 countries were included. Together they compared 23 different factors. Factors associated with increased risk were younger age (for <2 years old v older, odds ratio 3.41 (95% confidence interval 2.54 to 4.59), for