Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

Robinson, Marie-Ève; Li, Patricia; Rahme, Elham; Simard, Marc; Larocque, Isabelle; Nakhla, Meranda

doi:10.9778/cmajo.20190047

Cited by 19 publications

(17 citation statements)

References 40 publications

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“…Diabetic ketoacidosis (DKA) is seen in up to 50% of youth at presentation [17,18]. Forty-five per cent of children present with type 1 diabetes before 10 years of age [19] but there are two peaks in the age of presentation, the first at 4-6 years and the second at 10-14 years.…”

Section: Clinical Presentationmentioning

confidence: 99%

The changing face of paediatric diabetes

Shah

Nadeau

2020

Diabetologia

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The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.

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Section: Clinical Presentationmentioning

confidence: 99%

The changing face of paediatric diabetes

Shah

Nadeau

2020

Diabetologia

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“…5,6 Canadian data suggest recent prevalence rates of 18.6% to 25.6%. 7,8 Healthcare provider perceptions suggest a delay in diagnosis of children with new onset DM1 during the COVID-19 pandemic due to possible fears around virus transmission during healthcare appointments and under-recognition of symptoms secondary to reduced face-to-face interactions with medical providers. 9 Recent evidence has emerged showing an increase in severe ketoacidosis at diabetes diagnosis in children in Germany, Italy, and Australia.…”

Section: Introductionmentioning

confidence: 99%

Diabetic ketoacidosis at type 1 diabetes diagnosis in children during theCOVID‐19 pandemic

Rosolowsky

Pacaud

et al. 2021

Pediatr Diabetes

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Objective: The COVID-19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID-19 public health measures were enacted.Research Design and Methods: A retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Rates of DKA and severe DKA were compared to the same time period in the year 2019 (pre-pandemic control). Results:The number of children presenting with newly diagnosed DM1 was similar during the pandemic year of 2020 compared with 2019 (107 children in 2020 vs. 114 in 2019). The frequency of DKA at DM1 onset was significantly higher in the pandemic period (68.2% vs 45.6%; p < 0.001) and incidence of severe DKA was also higher (27.1% in 2020 vs 13.2% in 2019; p = 0.01).Conclusions: There was a significant increase in DKA and severe DKA in children presenting with new onset DM1 during the COVID-19 pandemic period. This emphasizes the need for educating health care professionals and families to be aware of the symptoms of hyperglycemia and the importance of early diagnosis and treatment even during public health measures for COVID-19.

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“…10 A study from the province of Quebec found that the rate of DKA at diagnosis of diabetes increased from 22% in 2001 to 30% in 2014, but the rates of DKA after diagnosis were not examined. 16 The factors contributing to the development of DKA at vs after diagnosis of type 1 diabetes are likely to be distinctive, and therefore it is of value to understand them as separate events to design effective preventative interventions. The objective of this study was to describe 11-year trends in the incidence of DKA at and after the diagnosis in a population-based cohort of individuals diagnosed with type 1 diabetes || Accepted Version || J Pediatr.…”

Section: Introductionmentioning

confidence: 99%

Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada

Kao

Islam

Fox

et al. 2020

The Journal of Pediatrics

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To estimate the 11-year incidence trend of diabetic ketoacidosis (DKA) at and after the diagnosis of type 1 diabetes. Study designA retrospective cohort study using a population-based administrative cohort diagnosed with type 1 diabetes at <20 years of age from 2002 to 2012 in British Columbia, Canada. DKA at (1 episode per individual) and DKA after (multiple episodes per individual) the diagnosis of diabetes were defined as DKA occurring ≤14 days or >14 days, respectively, from diagnosis, identified using International Classification of Diseases, 9th and 10th editions codes. Incidence rate ratios were estimated using Poisson regression and DKA trends using Joinpoint regression analyses. ResultsThere were 1519 individuals (mean age at first-DKA, 12.6 ± 5.9 years; 50% male) with ≥1 DKA episode identified. Of 2615 incident cases of type 1 diabetes, there were 847 (32.4%; mean age, 9.9 ± 4.8 years; 52% male) episodes of DKA at the diagnosis of diabetes. Among prevalent cases of type 1 diabetes (1790 cases in 2002 increasing to 2264 in 2012), there were 1886 episodes of DKA after the diagnosis of diabetes (mean age at first DKA, 15.7 ± 5.2 years). The rates per 100 person-years of DKA at diabetes diagnosis (ranging from 24.1 in 2008 to 37.3 in 2006) and DKA after diabetes diagnosis (ranging from 4.9 in 2002 to 7.7 in 2008) remained stable. Females showed a 67% higher rate of incidence of DKA after the diagnosis of diabetes compared with their male counterparts (incidence rate ratio, 1.67; 95% CI, 1.50-1.86; P < .001), adjusted for the temporal trend by fiscal year. Younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis and older children (≥10 years) had a greater risk of DKA after the diagnosis of diabetes. ConclusionsThe risk of DKA at the time of diagnosis of diabetes was greater with younger age and the risk of DKA after the diagnosis of diabetes was higher in females and older children and youth.

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Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

Cited by 19 publications

References 40 publications

The changing face of paediatric diabetes

The changing face of paediatric diabetes

Diabetic ketoacidosis at type 1 diabetes diagnosis in children during theCOVID‐19 pandemic

Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada

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