High prevalence of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes in Belgrade, Serbia: 10-year tertiary centre experience

Abstract

_______ 7 SAŽETAK Uvod/cilj: Dijabetesna ketoacidoza (DKA) je najznačajniji uzrok mortaliteta mladih sa tipom 1 dijabetesa melitusa (T1DM). Rezultati poslednjih istraživanja ukazuju na zabrinjavajuće visoku prevalenciju DKA u trenutku postavljanja dijagnoze T1DM kod mladih u Beogradu. Cilj ovog istraživanja bila je procena učestalosti DKA kod dece i adolescenata sa novootkrivenim T1DM tokom desetogodišnjeg perioda u tercijernom centru u Beogradu. Metode: Podaci su prikupljeni retrospektivnom pretragom medicinske dokumentacije sve dece i adolescenata sa novootkrivenim T1DM koji su bili hospitalizovani u našem centru tokom perioda od 1. januara 2007. godine do 1. januara 2017. godine. Rezultati: Dijagnoza novootkrivenog T1DM postavljena je kod ukupno 501 deteta (233 devojčice i 268 dečaka) prosečnog uzrasta 9,55 ± 4,26 godina, sa prosečnom vrednošću pH od 7,28 ± 0,14 (6,78-7,51) u trenutku postavljanja dijagnoze. Devojčice sa T1DM su u proseku bile mlađe u odnosu na dečake (9,05 ± 4,04 god. u odnosu na 9,98 ± 4,41 god, respektivno, p<0.05). Od ukupnog broja pacijenata, 191 (38,1%) je u trenutku postavljanja dijagnoze imao DKA, od čega je 47.6% bilo u blagoj, 26,2% u umerenoj, a 26,2% u teškoj ketoacidozi. U grupi mlađe dece, uočena je veća učestalost DKA (40%) u odnosu na grupu dece uzrasta > 11 godina (35%), ali ova razlika nije bila statistički značajna. Zaključak: Rezultati ukazuju na zabrinjavajuće visoku prevalenciju DKA u trenutku postavljanja dijagnoze T1DM kod mladih u Beogradu, bez značajne razlike u odnosu na uzrast. Ovi nalazi ukazuju na potrebu SUMMARY Introduction/Aim: Diabetic ketoacidosis (DKA) is one of the most important causes of acute mortality in youth with type 1 diabetes mellitus (T1DM). Recently published data suggested worryingly high frequency of DKA at the onset of T1DM in Belgrade youth. The goal of this study was to assess the frequency of DKA at the onset of T1DM and the associated risk factors in Belgrade youth during the previous 10 years at a tertiary centre. Methods: Data were collected retrospectively from the medical records of all children with new-onset T1DM admitted to our centre during the study period between 1st January 2007 and 1st January 2017. Results: During the study period, a total of 501 subjects (233 girls and 268 boys) were diagnosed with new-onset T1DM, with a mean age of 9.55 ± 4.26 years, and mean pH at the time of diagnosis of 7.28 ± 0.14 (6.78-7.51). Girls with T1DM were younger compared to boys (9.05 ± 4.04 years vs. 9.98 ± 4.41 years, respectively, p < 0.05). Of all patients, 191 (38.1%) presented with DKA, 47.6% of which were classified as mild, 26.2% as moderate and 26.2% as severe DKA. Slightly higher frequency of DKA was noticed in the younger age groups (40%) compared to the children > 11 years (35%), although this difference was not statistically significant. Conclusion: There is an alarmingly high rate of DKA at the onset of T1DM in Belgrade youth with no significant differences between different age groups. These findings emphasize the need for intens...

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

“…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) .…”

Assessment of health-related quality of life in pediatric patients with type 1 diabetes - a preliminary study

“…The life of these chronically ill chil-dren is specific, because management of T1DM is often complex and requires a high degree of patient and family involvement, decision making and regular glucose monitoring, injections of insulin and dose adjustments, carbohydrate estimation, therapy adjustments according to physical activity, emotional status, illness or infections, alcohol intake. Children with T1DM rate their own HRQOL as similar to their healthy peers [2][3][4][5], but they report disease specific problems, which are described in the literature [2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Previous studies highlighted that several factors are associated with poor metabolic control and worse HRQOL in children with T1DM such as: female gender, older adolescents, lower family income, social minority status, single parenthood, and lower level of adherence to treatment [2,3].…”

“…The analysis of the National Diabetes Registry of Serbia for 2010 [21], 2014 [22], and 2017 [23], showed a large annual increase of newly diagnosed pediatric patients with T1DM, especially in those aged 5 -9 and 10 -14 years. Todorović et al found that during the ten-year period (from January 2007 to January 2017), 501 children with newly diagnosed T1DM were hospitalized at the Mother and Child Healthcare Institute of Serbia "Dr. Vukan Čupić" [6]. Therefore, the aim of the study was to assess the HRQOL in pediatric patients with T1DM and its association with sociodemographic (age, gender, and time since diagnosis in years) and clinical factors (glycosylated hemoglobin (HbA1c) levels and type of insulin therapy).…”