Diabetic Ketoacidosis at the Time of Diagnosis of Type 1 Diabetes in Children

Abstract

Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood. If left untreated, diabetic ketoacidosis (DKA), a largely preventable life-threatening complication, will occur. Currently, 19% of Canadian children and 40% of US children will present with DKA at the time of diagnosis of T1D. 1,2 Because symptoms of T1D exist before the onset of DKA, 1 risk factor for DKA is a delay in the diagnosis and treatment of T1D. Other risk factors include younger age (<5 years) and lower socioeconomic status (SES). 1 Several prospective studies, including the Trial to Reduce Insulin Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR), have followed up children at increased genetic risk of T1D from birth. 3,4 Within these research settings, there was an increased awareness of diabetes risk and symptoms provided by the research teams, likely leading to earlier diagnosis and a decreased DKA risk at diagnosis. In a longitudinal study of children at increased genetic risk of T1D (the En-vironmental Determinants of Diabetes in the Young [TEDDY] study), participants experienced significantly less DKA at the time of diagnosis when compared with patients with newonset T1D reported in national diabetes registries. 4 The objectives of this cohort study were to assess (1) the risk of DKA at T1D diagnosis in children followed up in the prospective TRIGR study and (2) whether participation in TRIGR, in which parents are aware of their child's increased risk of developing T1D, is associated with decreased SES and age disparities in DKA risk at the time of diagnosis.

Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation

“…Overall, the clinical presentation of children participating in the population-based Fr1da screening was comparable to that of children diagnosed with presymptomatic type 1 diabetes by islet autoantibody screening in natural history studies [ 7 , 11 ], or clinical trials [ 38 ], and similarly with respect to stress and anxiety levels in parents in response to screening. Previous findings from the Fr1da study indicated that psychological stress scores were transiently elevated in mothers of children diagnosed with presymptomatic type 1 diabetes in the Fr1da screening and that the distress reported by the families was low or moderate in the majority of families [ 18 ], consistent with findings in children diagnosed with islet autoantibodies in natural history studies [ 39 , 40 ] and in parents of children identified with an increased genetic risk for type 1 diabetes [ 41 , 42 ].…”