Diabetic Ketoacidosis as the Initial Presentation of Type 1 Diabetes in Children and Adolescents: Epidemiological Study in Southern Brazil

Souza, Leonardo Calil Vicente Franco de; Kraemer, Gabriela de Carvalho; Koliski, Adriana; Carreiro, José Eduardo; Cat, Mônica Nunes Lima; Lacerda, Luiz de; Nesi-França, Suzana

doi:10.1590/1984-0462/2020/38/2018204

Cited by 22 publications

(15 citation statements)

References 24 publications

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“…The proportions of children who were positive for GADA, IAA, and ICA, were 29.4%, 15.2%, and 11.8%, respectively. In a previous Brazilian study, the frequency of antibody positivity was 56.8% for GAD, 43.7% for ICA, and 26.3% for IAA (12). Of the 241 T1DM patients presenting at <15 years of age in Melbourne, Australia, 58.9% of cases were GAD seropositive and 42.3% were IAA seropositive.…”

Section: Discussionmentioning

confidence: 80%

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

Hou

Liu

et al. 2021

Front. Endocrinol.

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PurposeTo investigate the features and treatment status of children with type 1 diabetes mellitus (T1DM) in China.MethodsWe recruited patients <14 years of age with T1DM from 33 medical centers in 25 major cities of China between January 2012 and March 2015. All patients completed a questionnaire that was conducted by their pediatric endocrinologists at all centers.ResultsA total of 1,603 children (755 males and 848 females) with T1DM participated in this survey. Of these, 834 (52.03%) of the patients exhibited diabetic ketoacidosis (DKA) at onset, while 769 patients (47.97%) did not exhibit DKA (non-DKA) at onset. There was a higher proportion of females (55.71%) in the cohort of patients exhibiting DKA at onset than in the non-DKA cohort (49.33%). The mean age of patients exhibiting DKA at presentation was 7.12 ± 0.14 years; this was significantly younger than that in non-DKA group (7.79 ± 0.15 years; P < 0.005). The frequency of DKA in 3 years old, 3-7 years old, and 7 years old or more was 77.21%, 26.17%, and 37.62%, respectively. Upon initial diagnosis, 29.4%, 15.2% and 11.8% of patients showed positivity for glutamic acid decarboxylase antibody (GADA), Insulin autoantibodies (IAA), or islet cell antibody (ICA), respectively. During six months follow-up, 244 patients (15.21%) reported receiving insulin pump therapy, and more than 60% of patients monitored their blood glucose levels less than 35 times per week. Although the majority of patients had no problems with obtaining insulin, 4.74% of the children surveyed were not able to receive insulin due to financial reasons, a shortage of insulin preparations, or the failure of the parents or guardians to acquire the appropriate medicine.ConclusionDKA is more common in very young children. Treatment and follow-up of T1DM in China still face very serious challenges.

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Section: Discussionmentioning

confidence: 80%

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

Hou

Liu

et al. 2021

Front. Endocrinol.

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“…5,15,16 In our study, most patients had ended the "honeymoon" period, which is an early and transient phase of T1DM with less need for exogenous insulin (below 0.5 IU/kg/day), due to persistent insulin secretion by the remaining beta cells. 17 They were also in puberty, with higher levels of growth hormones (GH), glycemia-counteracting hormone and, consequently, greater need for daily insulin for metabolic control. 18 These factors may have influenced the mean HbA1c in the studied population.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus

Silva

Piano

Fernandes

et al. 2022

Rev. paul. pediatr.

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Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

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“…Learning how to acknowledge hyperglycemia symptoms is very important at the school environment. It can make a way for an early diabetes screening, often avoiding the sudden onset of T1DM in a severe and traumatic way such as ketoacidosis [29].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a diabetes educational intervention at primary school

Mourão

Sedlmaier

Pires

et al. 2022

Int J Diabetes Dev Ctries

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Background Brazil ranks fifth in the world in the number of adults with diabetes, and third for type 1 diabetes. Conducting educational actions on this topic in public schools in this country is extremely important, since it can assist in the early adoption of good life habits and in a better care for students in this condition.Objective The aim of this study was to assess the effectiveness of an educational intervention about diabetes for students and school staff. Methods This is an interventional non-randomized longitudinal study, in which interviews were conducted before and after a playful intervention with the use of theater play and games for students and plus a training for the school staff. Results A total of 89 participants completed the study, being 73 students aged 7 to 12 years old, and 16 school staff. As a result, there was a positive change in knowledge and perception of diabetes by the students. The greatest changes in the answers among the participants, at the post-intervention period, were related to the possibility of consuming something with sugar by those with diabetes, and particularly how to cope in hypoglycemia situations by the school staff. Conclusions Actions like these must be encouraged within the school environment, especially in countries with high prevalence of diabetes.

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Diabetic Ketoacidosis as the Initial Presentation of Type 1 Diabetes in Children and Adolescents: Epidemiological Study in Southern Brazil

Cited by 22 publications

References 24 publications

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus

Effectiveness of a diabetes educational intervention at primary school

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