Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Abstract

Background. Diabetic ketoacidosis (DKA) is a life-threatening condition frequently present at type 1 diabetes diagnosis (T1D). Younger children are at greater risk of developing this acute complication. It is alarming due to worldwide rise in T1D incidence with the greatest increase in children aged < 5 years. The aim of this study was to identify the prevalence of DKA and factors related to its occurrence in children at T1D diagnosis from Wielkopolska province in Poland. Methods. The study cohort comprised 735 children (girls: 329; boys: 406) aged 0-18 years with new onset T1D admitted to one hospital between 2009 and 2014. The mean age at diagnosis was 9.3 years. DKA was defined as blood pH < 7.30. To confirm autoimmune diabetes origin typical autoantibodies were tested. Results. DKA was diagnosed in 36% of patients with newly diagnosed T1D. DKA occurred significantly more often in children aged < 4 years (p = 0.001). The highest prevalence of DKA was associated with symp-toms' duration (> 28 days) (p = 0.014) and diabetes misdiagnosis (p = 0.001). Autoantibody against zinc transporter 8 was detected significantly more often in children with DKA (p = 0.044). In the group with DKA, glycated hemoglobin level was significantly higher (p = 0.0004), while insulin and C-peptide levels were lower (p = 0.0001 and p = 0.0001, respectively). Conclusions. The prevalence of DKA is high and its severity is substantial in children with newly diagnosed T1D from Wielkopolska province. Diabetes misdiagnosis, symptoms' duration and age under 4 years are the most common risk factors of DKA development at T1D onset. Autoantibody against zinc transporter 8 is associated with acute T1D onset.

Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study

“…The frequency of severe DKA remained constant at a level of approximately 28-30% of all DKA cases [13]. This is consistent with previous observations from other Polish centers, with severe DKA rate at the level between 24% (Greater Poland) [16], and 31.4% (Lesser Poland) [15]. Global statistics on severe DKA incidence vary between 22 to 37% [22][23][24][25].…”

“…In previous years, DKA 12-month prevalence in our center was noticeably lower, and varied from 25 to 28%, without differences between the periods from 2006 to 2007 and from 2013 to 2014 [6], similar to the DKA prevalence among children in the area of eastern and central Poland (which cover around 35% of the Polish population) [14]. In another regions of Poland, the incidence of DKA at diagnosis of T1D was about 22-26%, although did not exceed 36% [15][16][17]. Therefore, based on these findings, we may conclude that in comparison to recent years, DKA incidence in our center during 3 months of pandemic state has roughly doubled.…”

“…A positive family history of diabetes is one of the protective factors associated with a reduced risk of DKA [28,32]. In contrary, first-degree relative with T1D did not affect DKA occurrence in study by Niechciał et al [16]. Our research did not reveal a significant difference in family history between groups, therefore we did not perform sub analysis on the its correlation with incidence or severity of DKA.…”

Is Diabetic Ketoacidosis A Good Predictor Of 5-Year Metabolic Control in Children with Newly Diagnosed Type 1 Diabetes?

“…[1,2] The alarming epidemiological situation may also be observed in Poland with the tendency toward younger age groups. [3] In children aged 0-14 the disease frequency boosted approximately six-fold from 4.2 per 100 000 persons/year in the early 1970s to 24.3 per 100 000 persons/year in 2013 with regular, sinusoidal uctuations and a slight levelling-off over the past few years. [3,4,5] The International Society for Pediatric and Adolescent Diabetes (ISPAD) stated that diabetic ketoacidosis (DKA) was the most common, but potentially preventable life-threatening complication related to newly diagnosed T1D.…”

“…[3] In children aged 0-14 the disease frequency boosted approximately six-fold from 4.2 per 100 000 persons/year in the early 1970s to 24.3 per 100 000 persons/year in 2013 with regular, sinusoidal uctuations and a slight levelling-off over the past few years. [3,4,5] The International Society for Pediatric and Adolescent Diabetes (ISPAD) stated that diabetic ketoacidosis (DKA) was the most common, but potentially preventable life-threatening complication related to newly diagnosed T1D. [6] The incidence of this problem is still unacceptably high, especially in the youngest group (below 5 years) and has not changed over the last 20 years despite a sharp increase in T1D diagnoses and improvement in medical care.…”