Delayed diagnosis of diabetic ketoacidosis in children—a cause for concern

Varadarajan, Poovazhagi; Suresh, Saradha

doi:10.1007/s13410-014-0245-4

Cited by 11 publications

(19 citation statements)

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“…However only fluid refractory shock, azotemia and younger age were identified to be significant risk factors for cerebral edema in multivariate analysis [11] . Literature from Chennai-India has revealed cerebral edema in 24% of study group [3] . In this prospective study of 118 children with DKA, specific risk factor related mortality for cerebral edema was 43%.…”

Section: Dka Related Cerebral Edemamentioning

confidence: 92%

“…Cerebral edema was significantly associated with altered sensorium, lower PaCO2 at admission, delayed diagnosis and failure of sodium to rise with therapy by multivariate analysis. Both the studies from India have identified higher fluids as risk factors for cerebral edema in univariate analysis but were not significant in multivariate analysis [3,11] . This may be an important observation in developing countries where sepsis has been an important factor associated with increased mortality in children with DKA.…”

Section: Dka Related Cerebral Edemamentioning

confidence: 96%

“…In their series, sepsis was the triggering factor in one third of cases. In study from ChennaiIndia, infections were encountered in 61 children among the study group of 118 children [3] . Of these 49 had identified focus of infection (41.5%).…”

Section: Sepsis In Dkamentioning

confidence: 99%

“…Similarly the cause for mortality in DKA varies between developed countries and developing countries. Cerebral edema is the predominant cause for mortality in children with DKA from developed countries, while recent data from developing countries has shown higher incidence of cerebral edema, sepsis, shock and renal failure as the cause for death in DKA [3] . Delayed diagnosis has been identified as a major risk factor associated with mortality in children from Chennai-India [3] .…”

Section: Introductionmentioning

confidence: 98%

“…Cerebral edema is the predominant cause for mortality in children with DKA from developed countries, while recent data from developing countries has shown higher incidence of cerebral edema, sepsis, shock and renal failure as the cause for death in DKA [3] . Delayed diagnosis has been identified as a major risk factor associated with mortality in children from Chennai-India [3] . Overall mortality in children with DKA varies from 0.15% to 0.35% in developed countries like Canada, United States and United Kingdom [4][5][6][7] and from 3.4% to 13.4% in developing countries like India, Pakistan and Bangladesh [8][9][10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 98%

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Risk factors for mortality in children with diabetic keto acidosis from developing countries

Varadarajan¹

2014

WJD

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Diabetic keto acidosis (DKA) is the major cause for mortality in children with Diabetes mellitus (DM). With increasing incidence of type 1 DM worldwide, there is an absolute increase of DM among children between 0-14 year age group and overall incidence among less than 30 years remain the same. This shift towards younger age group is more of concern especially in developing countries where mortality in DKA is alarmingly high. Prior to the era of insulin, DKA was associated with 100% mortality and subsequently mortality rates have come down and is now, 0.15%-0.31% in developed countries. However the scenario in developing countries like India, Pakistan, and Bangladesh are very different and mortality is still high in children with DKA. Prospective studies on DKA in children are lacking in developing countries. Literature on DKA related mortality are based on retrospective studies and are very recent from countries like India, Pakistan and Bangladesh. There exists an urgent need to understand the differences between developed and developing countries with respect to mortality rates and factors associated with increased mortality in children with DKA. Higher mortality rates, increased incidence of cerebral edema, sepsis, shock and renal failure have been identified among DKA in children from developing countries.Root cause for all these complications and increased mortality in DKA could be delayed diagnosis in children from developing countries. This necessitates creating awareness among parents, public and physicians by health education to identify symptoms of DM/DKA in children, in order to decrease mortality in DKA. Based on past experience in Parma, Italy it is possible to prevent occurrence of DKA both in new onset DM and in children with established DM, by simple interventions to increase awareness among public and physicians. Key words: Diabetic keto acidosis; Mortality; Cerebral edema; Sepsis; Shock; Delayed diagnosis Core tip: Mortality in Diabetic keto acidosis (DKA) among children from developed countries is due to cerebral edema and is very low. The mortality in DKA among children from developing countries is due to higher incidence of cerebral edema, sepsis, shock and renal failure. Delayed diagnosis is the root cause for high mortality in children with DKA from developed countries. There is an urgent need to increase the awareness about diabetes among the public and physicians.Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes 2014; 5(6): 932-938 Available from:

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Section: Dka Related Cerebral Edemamentioning

confidence: 92%

Section: Dka Related Cerebral Edemamentioning

confidence: 96%

Section: Sepsis In Dkamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Risk factors for mortality in children with diabetic keto acidosis from developing countries

Varadarajan¹

2014

WJD

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Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients

et al. 2022

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ImportancePresenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating.ObjectiveTo evaluate factors associated with DKA at the onset of T1D among pediatric patients.Evidence ReviewIn this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model.FindingsA total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (&lt;2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P &lt; .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P &lt; .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P &lt; .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P &lt; .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P &lt; .001).Conclusions and RelevanceIn this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.

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Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: a cross-sectional analysis of nationally representative survey data

Matthews¹,

Coates²,

Bukhman³

et al. 2023

eClinicalMedicine

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Delayed diagnosis of diabetic ketoacidosis in children—a cause for concern

Cited by 11 publications

References 19 publications

Risk factors for mortality in children with diabetic keto acidosis from developing countries

Risk factors for mortality in children with diabetic keto acidosis from developing countries

Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients

Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: a cross-sectional analysis of nationally representative survey data

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