Epidemiology of Diabetic Ketoacidosis in the Waikato Region of New Zealand: 2000-2019.

Aims: Diabetic ketoacidosis (DKA) is not well characterised in New Zealand. This study is aimed at characterising the change in epidemiology and severity of DKA from 2000 to 2019 at a tertiary hospital in the Waikato region of New Zealand. Methods: A retrospective clinical data review of all patients admitted to Waikato District Health Board hospitals with DKA was undertaken. Characteristics and severity of DKA were assessed by type of DKA admission (diagnosed at admission, nonrecurrent, and recurrent), ethnicity, social deprivation, intensive care unit (ICU) admission, and length of hospital stay, with linear regression reporting on changes over time. Results: There were 1254 admissions for DKA (564 individual patients), two-thirds being recurrent events. Nonrecurrent DKA patients were younger, whilst recurrent admissions for DKA were associated with T1D, female gender, greater socioeconomic deprivation, and rural living (all P values < 0.01). DKA admission increased 8-fold between 2000 and 2019, mostly due to an increased number of recurrent events, particularly in Maori and female patients (P < 0.001). ICU admissions increased over time (P < 0.001) whilst length of hospital stay trended down (P = 0.031). Conclusions: The rise in recurrent DKA is concerning, particularly in youth and indigenous Maori. Healthcare inequities need to be addressed, including adequate access to mental health support to ensure optimal outcomes for all patients with diabetes.

The psychological profile of youth and young adults with type 1 diabetes in New Zealand.

BACKGROUND: The psychological status of New Zealanders living with type 1 diabetes (T1D) is unknown. This study's purpose is to determine the prevalence of general wellbeing, diabetes-specific distress, and disordered eating, and explore their relationships with glycemic control. METHODS: Participants were patients aged 15-24 years with T1D (N = 200) who attended their routine multidisciplinary clinic at the Waikato Regional Diabetes Service. They completed questionnaires including the World Health Organization Well-Being Index, the Problem Areas in Diabetes scales, and the Diabetes Eating Problem Survey-Revised. Clinical and demographic information were also collected. RESULTS: Median age of participants was 19.3 years and 14% identified as Maori (indigenous people of Aotearoa New Zealand). Median HbA1c was 73 mmol/mol. One fifth of participants experienced low emotional wellbeing, including 7.5% who experienced likely depression. Diabetes distress was found in 24.1%, and 30.7% experienced disordered eating behaviors. Differences were identified between Maori and non-Maori in measures of diabetes distress and disordered eating, with Maori more likely to score in clinically significant ranges (50% vs. 19.9%; 53.6% vs. 26.7%, p < 0.05). Disordered eating was correlated with HbA1c , body mass index, and social deprivation; diabetes distress was associated with HbA1c and inversely with age (all p < 0.05). CONCLUSIONS: This study is the first of its kind to determine that New Zealanders living with T1D experience significant psychological distress. Research with larger Maori representation is needed to more closely review identified inequities. Replication in other local clinics will help contribute to the ongoing development of normative data for Aotearoa New Zealand.

The prevalence of microvascular complications in Waikato children and youth with type 1 diabetes has reduced since 2003.

AIMS: To determine whether glycaemic control and the prevalence of microvascular complications in Waikato children/youth with type 1 diabetes (T1D) has changed since 2003. METHODS: A retrospective review was performed of clinical records of children and youth with T1D who were under the care of the Waikato Paediatric and Young Adult Diabetes Services between March 2016 and March 2017. Comparisons were made to published data from the same service in 2003. RESULTS: Despite a more than two-fold increase in insulin-pump therapy since 2003, glycaemic control was not significantly improved in either children or youth. However, since 2003 there has been a significant reduction in the prevalence of diabetic retinopathy (24.6% vs 6.0%; P=0.003) and nephropathy (6.0% vs 25.4%; P=0.002), while symptomatic diabetic neuropathy remains rare. This reduction occurred despite a significant increase in obesity and hypertension, and no significant difference in the rates of dyslipidaemia or smoking. CONCLUSIONS: There has been a marked reduction in microvascular complications in Waikato youth and young adults with type 1 diabetes, but the reasons for the reduction are not clear given there has been no significant improvements in glycaemic control.