Clinical characteristics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes

Arafa, Noha; Hassan, Mona; Atef, Shimaa; Fathallah, Asmaa Salah Eldin; Ibrahim, Amany

doi:10.5603/dk.2020.0042

Cited by 3 publications

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“…The finding of vomiting accompanied by dehydration signs, polysymptoms, and abdominal pain in the present study aligns with studies done in northern and central Ethiopia (7,8,17,30) as well as other studies where polysymptoms were the dominant presentations (3,19,24,31,32,33,34) .In addition, the identification of infectious precipitants, particularly pneumonia, diarrheal diseases, and urinary tract infections, and as a predictor of DKA also favor the hypothesis that infections lead to acute metabolic decompensation and insulin resistance and subsequent development of diabetic ketoacidosis (28) .…”

Section: Discussionsupporting

confidence: 93%

“…This is much higher than the study conducted in Ethiopian capital, Addis Ababa (35.8%), which was 80% 15 years back( 7,17 ), but much lower than in northern part of Ethiopia, Tigray(78.7%)( 8 ).The high level literacy of the community and the availability of wide range of awareness creation methods(such as screening, posters, flyers and awareness campaigns) in the capital might explain the sharp decline in the incidence. The model was demonstrated in Germany, where the incidence was reduced from 28% to 16% through the Stuttgart ketoacidosis campaign, which focused on the symptoms of type 1 DM ( 10 ).In addition, the current prevalence is higher than that in other African countries such as Egypt(46%)( 15 ), Sudan(17.6%)( 18 ), and Tanzania(43%)( 19 ), but lower than that in two studies in Nigeria(100%)( 9 ) ( 77%)( 20 ).Outside the African continent, the reported prevalence was UK(25%)( 21 ), Germany(20%)( 22 ), Finland(19.4%)( 23 ), Sweden(16%), USA (30%), Canada (18.6%)( 16 ), Kuwait (35.9%), and China (50.1%)( 24 ), all showing wide geographic variation in its incidence. Various factors have been identified for a wide range of variations, including variations in the prevalence of diabetes, demonstrating an inverse relationship between type 1 diabetes mellitus prevalence and DKA incidence ( 25, 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies have demonstrated and linked an increased incidence to multiple factors. For instance, younger age (9)(10)(11)(12)(13)(14) , uneducated parents, no relative with type1DM, residing in rural areas, and having low economic status were incriminated (9,12,13,15) .Nonetheless, not all the factors were explanatory (16) .…”

Section: Diabetic Ketoacidosis (Dka) Is a Common Complication Of Type...mentioning

confidence: 99%

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Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: prevalence and predictors

oyamo

2024

Preprint

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Background: Diabetic ketoacidosis is a morbid complication of diabetes mellitus, and its occurrence at diagnosis has rarely been studied in Ethiopia, despite the many cases seen in the pediatric population. Objective: To know the prevalence of diabetic ketoacidosis (DKA) among patients with newly diagnosed diabetes mellitus and identify avoidable risk factors. Method: This institution-based retrospective cross-sectional study was conducted from December 25, 2018 to December 25, 2022. Newly diagnosed type1 diabetes mellitus (DM) patients with age < 15 years were included in the study. DKA was diagnosed based on clinical presentation and blood glucose and urine ketone levels. A data collection form was prepared to collect sociodemographic and clinical data. Descriptive, bivariate, and multivariate logistic regression analyses were performed to identify the risk factors. Result: Among the admitted 61 newly diagnosed T1DM pediatric patients, DKA was the first presentation in 37 patients making 60.7% of newly diagnosed T1DM. Mean age at diagnosis was 8 years and females were affected more. Clinical presentation revealed vomiting accompanied by signs of dehydration (32.4%), with polysymptoms (29.7%) being the most common. Infectious morbidity occurred in 26 patients, 21 of whom were in the DKA group. Inadequate knowledge of signs and symptoms of DM adjusted odds ratio (AOR=0.07(0.019-0.0897), absence of a family history of DM (AOR=0.129 (0.019-0.897), and presence of infection prior to diagnosis of DKA (AOR=11.69(1.34-10.1) were potential predictors for the development of DKA among newly diagnosed T1DM patients. Conclusion: A very high number of children present with DKA at the initial diagnosis of diabetes mellitus (DM), which is attributed to inadequate knowledge of the signs and symptoms of DM and the masking effect of concomitant infections in these children. Healthcare professionals should endeavor to suspect and screen children. Continuous awareness creation of DM at the health professional and community levels is encouraged to diagnose diabetes mellitus earlier and to decrease the prevalence of DKA as an initial presentation. Key words: Child, diabetic ketoacidosis, Dilla, prevalence

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Diabetic Ketoacidosis (Dka) Is a Common Complication Of Type...mentioning

confidence: 99%

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Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: prevalence and predictors

oyamo

2024

Preprint

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“…In MENA region, a report by International Diabetes Federation (IDF) in 2019 estimated that 149400 children and adolescents were diagnosed with T1DM. And this number was increasing by 20800 yearly according to the same report (Arafa et al, 2020). In developing countries, the incidence of mortality in hyperglycemic emergencies such as diabetic ketoacidosis (DKA) varies from 4-40% (Shahid et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Diabetic ketoacidosis: Knowledge and awareness assessment among parents and caregivers of children and adolescents diagnosed by Type l DM in Saudi Arabia

Alshareef¹,

Ojayban²,

Alsallum³

et al. 2023

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Background: Diabetes mellitus type 1 is characterized by the absence of insulin. One of the most common complications of DM is Diabetic Ketoacidosis, which is caused by a prolonged decrease of insulin due to loss of pancreatic β-cells by the immune response developing many symptoms such as high glucose levels, ketonuria, irregular electrolytes and dehydration. DKA episodes in children with T1DM are considered an issue worldwide. DKA often occurs at the beginning of diagnosis of diabetes mellitus type 1. This study aims to determine knowledge and awareness of diabetes ketoacidosis among parents and caregivers who have children or adolescents diagnosed with T1DM. Methodology: The study was conducted in Saudi Arabia from August 2022 to November 2022 as a descriptive cross-sectional with a minimum sample size of 666. The data was collected using a questionnaire translated into Arabic language. The data was analyzed by using statistical package for the social sciences (SPSS, version 28). Results: In our research, there were 1055 respondents. Mothers of diabetic children made up 42.7% of research respondents, followed by sisters (21.9%), fathers (20.1%) and brothers (15.3%).Of the study's respondents, 53.1% had strong knowledge of diabetic ketoacidosis, 34.8% had lack of knowledge, 8.6% had low knowledge and 3.5% had no knowledge at all. Age, diabetes, occupation, working status and the age of a diabetic child were all substantially correlated with knowledge score. Conclusion:The majority of caregivers in this study demonstrate poor knowledge and awareness of the signs and symptoms of DKA, However, they still require extra education because the majority of them are uninformed of the significance of DKA management.

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Clinical features, biomarkers and diabetic ketoacidosis at diagnosis of type 1 diabetes among children and adolescents in Sana’a, Yemen

Gunaid,

Ogle,

Al-Qadasi

et al. 2024

bmjpo

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IntroductionThere is little published information on type 1 diabetes (T1D) in children in Yemen. We aimed to identify the clinical characteristics, biomarkers and diabetic ketoacidosis (DKA) at diagnosis of T1D among children and adolescents in a diabetes centre in Sana’a, Yemen.MethodsA total of 485 children and adolescents aged ≤18 years diagnosed with T1D during the period 2010–2020 were included in the study. The variables investigated were demographic and clinical characteristics, biomarkers, subtypes of T1D, and the risk factors for severe DKA at diagnosis.ResultsAt diagnosis, children aged <10 years compared with those aged ≥10 years had higher mean plasma glucose (p<0.001) and mean HbA1c (p=0.026), and lower mean C-peptide (pmol/L) (p=0.019), and a higher frequency of DKA at diagnosis than older children (p<0.001). A majority of the study population (383, 79%) presented in DKA . Children aged <10 years presenting with DKA had significantly longer median appraisal interval (p=0.009) and median total diagnosis interval (p=0.025), and significantly lower mean C-peptide (p=0.001) as compared with their peers without DKA. The prevalence of autoantibody-negative ‘idiopathic’ T1D was 36 (32%) of the total number tested for autoantibody and familial T1D 61 (12.6%) of all the study population.ConclusionIn Yemen children aged <10 years with new-onset T1D frequently faced the challenge of a delay in diagnosis and treatment initiation, with severe hyperglycaemia and a higher risk of DKA at diagnosis.

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Clinical characteristics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes

Cited by 3 publications

References 0 publications

Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: prevalence and predictors

Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: prevalence and predictors

Diabetic ketoacidosis: Knowledge and awareness assessment among parents and caregivers of children and adolescents diagnosed by Type l DM in Saudi Arabia

Clinical features, biomarkers and diabetic ketoacidosis at diagnosis of type 1 diabetes among children and adolescents in Sana’a, Yemen

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