We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0–14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1st January 2011 and 31st December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2–14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27–0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait.

Our study provides recent data on Middle Eastern population, for whom data are sparse. Although it has significantly decreased, the frequency of DKA at presentation of T1DM in children in Kuwait is still high, secondary to the high prevalence of diabetes in the community. Young children, especially those less than 2 yr old remain at high risk. Increasing the general awareness of the public as well as of pediatricians to the disease may lead to early diagnosis before the development of acidosis.

BackgroundType 1 diabetes mellitus (T1DM) is highly prevalent in Kuwait with incidence of around 40.1/100,000 individuals. Evidence indicate that vitamin D plays an important role in modulating the immune system and could thus impact the onset and high prevalence of T1DM. We report serum vitamin D levels in Kuwaiti children with T1DM and non-diabetic controls to explore its relationship with prevalence and onset of the disease.MethodsThis study included 216 Kuwaiti Arab children with T1DM. The diagnosis of T1DM was based on the ISPAD criteria. The control subjects (204 Kuwaitis) were age and gender matched, healthy, non-diabetic, and had no close relative with T1DM. Vitamin D levels were determined in serum using an enzyme immunoassay (EIA) method.ResultsThe age of onset of T1DM was <4y in 20 % of the T1DM cases, between 4 and 6y in 28 % cases and >6y in 52 % patients. In T1DM patient group, 84 % subjects were found to be deficient in serum vitamin D level compared to 77 % of the controls (p = 0.046). Collectively, the deficient and insufficient vitamin D status was detected in 99 % of the T1DM patients compared to 92 % of the controls (p = 0.027). The mean serum vitamin D levels were found to be significantly different in early onset cases (age <4y) compared to the late onset sub-group (p = 0.001). A significant correlation was found between some elements of socioeconomic status, SES (i.e. parent’s profession and family’s income) and lower vitamin D levels in Kuwaiti T1DM children. There was no significant difference between mean serum vitamin D levels during winter and summer months in the T1DM patients.ConclusionsThe proportion of cases with a deficient vitamin D status was significantly high in Kuwaiti T1DM children compared to the controls. The serum vitamin D levels were found to be significantly different in early onset and late onset T1DM patients. Therefore, serum vitamin D status can be considered an important contributor in high prevalence of T1DM in Kuwaiti children.

Background: Health related quality of life (HRQOL) has become a field of extensive research involving children and adolescents with diabetes. There are no HRQOL instruments designed or adapted for the Arabic culture and language. The objectives of the study are to test the Arabic translated version of the PedsQL^TM 4.0 Generic Core Scales (GCS) and the PedsQL^TM 3.0 Diabetes Module (DM) in children and adolescents with type 1 diabetes (T1DM) in Kuwait and analyse their psychometric properties. Methods: After the process of translation, committee review and pre-testing (linguistic validation), 131 children and adolescents with and 104 without T1DM, with their parents completed the Arabic version of GCS. Those with T1DM completed the Arabic DM. Demographic and diabetes-related data were collected using specially designed questionnaires. Internal consistency was checked by Cronbach’s alpha coefficient. The intraclass correlations coefficient, celling and floor effects and construct validity were assessed to determine the psychometric properties of both instruments. Results: Cronbach’s alpha of the child self-report and parent proxy-report was greater than 0.70, for both instruments, indicating internal consistency reliability. Items of both instruments had minimal missing responses, and required a brief time (5 - 7 minutes) to finish indicating their feasibility. No floor effect was demonstrated. Ceiling effect ranged from 5.8% to 15.8%. The GCS distinguished between healthy and diabetic children. The intraclass correlation coefficient (ICC) between child self-report and parent proxy-report of GCS scores showed good to excellent agreement, p < 0.001. However, in the DM reports, the correlation was lower, but still significant. Girls reported lower HRQOL scores in worries and communication subscales of the diabetes module than boys, p < 0.05. Conclusions: The Arabic version of the PedsQL GCS and PedsQL DM showed sufficient feasibility, reliability and validity to be used for research purposes in public health setting for children 2 - 18 years old and their parents

Background The incidence of type 1 diabetes mellitus (T1DM) in Kuwait is amongst the highest in the world. Vitamin D is considered to be involved in immune modulation and its deficiency contribute to autoimmune destruction of insulin producing beta cells in T1DM patients. Vitamin D has been shown to exert its effects via a nuclear vitamin D receptor (VDR) and therefore, VDR gene may be considered a candidate for T1DM susceptibility. Methods The genotypes of four VDR gene polymorphisms were determined in 253 Kuwaiti Arab T1DM patients and 214 healthy controls by PCR-RFLP analysis. Serum concentrations of three autoantibodies i.e. ICA (Islet cell autoantibody), GADA (Glutamic acid decarboxylase) and INS (Insulin autoantibody) were determined by radio-immunoassays. Results Statistically significant differences were detected between the genotypes of two VDR gene polymorphisms ( Fok I, C > T, rs10735810 and Taq I, C > T, rs731236) between T1DM patients and controls ( P < 0.0001). In both, the frequency of variant alleles was considerably high in T1DM than in the controls. In contrast, the VDR gene Apa I (G > T, rs7975232) and Bsm I (A > G, rs1544410) polymorphisms did not show association with T1DM. The homozygous variant genotypes of Fok I, Apa I and Taq I polymorphisms show significant differences between various age-of-onset subgroups while no such association was detected in the case of Bsm I polymorphism. Significant differences were also noted between heterozygous genotypes of all four polymorphisms especially between 4-6y and > 6y age-of-onset subgroups of T1DM patients. Three autoantibodies, ICA (Islet cell), GADA (glutamate decarboxylase) and INS (insulin) were positively associated to, varying degrees, with T1DM in Kuwaiti Arabs harboring different VDR gene polymorphism genotypes. Conclusions Our results demonstrate a significant effect of two VDR gene polymorphisms ( Fok I and Taq I) and three autoantibodies on genetic susceptibility of T1DM in Kuwaiti Arabs along with other factors.