Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study

Nakhla, Meranda; Rahme, Elham; Simard, Marc; Larocque, Isabelle; Legault, Laurent; Li, Patricia

doi:10.1503/cmaj.170676

Cited by 24 publications

(25 citation statements)

References 32 publications

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“…We have previously documented that 41% of children with newly diagnosed T1D living in Quebec did not have a usual provider of primary care and that having a primary care provider was associated with a reduced DKA risk at diagnosis in children older than 5 years of age. 26 Furthermore, wait times for urgent primary care visits are longer in Canada than in other countries and continue to increase. 31 Lack of physician and public awareness of the signs and symptoms of T1D may be another contributor to the increasing trends in DKA.…”

Section: Discussionmentioning

confidence: 99%

“…We chose a 3-day window as this was considered a reasonably short period wherein a patient was probably in DKA at the time of diagnosis. 26 These DKA codes have been used in previous studies in children to identify DKA within Canadian health administrative databases, ensuring that outcomes were measured consistently and using the same criteria. [26][27][28]…”

Section: Outcomementioning

confidence: 99%

“…These age groups have been previously shown to have differing risks associated with DKA at diagnosis. 13,26 The material and social deprivation index and rural status were assigned from the person's residential postal code at diabetes diagnosis. The material deprivation index is based on employment, education level and income.…”

Section: Patient Characteristics At Diagnosismentioning

confidence: 99%

“…Although our study population was restricted to 1 province, access to primary care is suboptimal across all provinces and thus our study probably provides a generalizable representation of DKA rates at diagnosis across Canada. 26,31 The diagnosis of DKA was based on administrative data and not on biochemical grounds; as such, we could not distinguish between the varying severities of DKA. Further, we could not adjust for other factors associated with DKA such as ethnicity or family history of diabetes, because these are not captured in provincial administrative databases.…”

Section: Limitationsmentioning

confidence: 99%

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

Robinson

Rahme³

et al. 2019

cmajo

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Background: Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec. Methods: We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis. Results: We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age-and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03). Interpretation: Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes.

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Section: Discussionmentioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

Section: Patient Characteristics At Diagnosismentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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

Robinson

Rahme³

et al. 2019

cmajo

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“…Anak yang berkunjung secara rutin dan menetap pada dokter keluarga atau dokter anak memiliki risiko yang lebih rendah terdiagnosis DM tipe-1 saat KAD. 32 Sebaliknya, KAD saat diagnosis berhubungan signifikan dengan penghasilan keluarga yang rendah, ketiadaan asuransi kesehatan, dan pendidikan orang tua yang rendah. 30 Pemantauan dan edukasi mengenai hipoglikemia merupakan salah satu komponen utama tata laksana 33 Selain pemantauan komplikasi akut, perlu juga dilakukan skrining komplikasi kronik yang dapat dibedakan menjadi komplikasi mikrovaskular dan makrovaskular.…”

Section: Komplikasi Dm Tipe-1unclassified

Diabetes Melitus Tipe-1 pada Anak: Situasi di Indonesia dan Tata Laksana

Pulungan

Annisa

Imada

2019

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Insidens Diabetes Mellitus (DM) Tipe-1 pada anak di dunia dan Indonesia terus meningkat. Berdasarkan data Ikatan Dokter Anak Indonesia (IDAI), tercatat 1220 dengan DM tipe-1 pada tahun 2018. Kesadaran masyarakat dan tenaga kesehatan mengenai DM pada anak masih rendah, yang direfleksikan melalui tingginya angka anak yang terdiagnosis dengan DM tipe-1 saat mengalami ketoasidosis diabetikum mencapai 71% pada tahun 2017. Berdasarkan pedoman IDAI, terdapat lima pilar penanganan DM tipe-1 pada anak: injeksi insulin, pemantauan gula darah, nutrisi, aktivitas fisik, dan edukasi. IDAI merekomendasikan insulin minimal dua kali per hari menggunakan insulin basal dan kerja cepat. Pemantauan gula darah mandiri dilakukan minimal 4-6 kali per hari. Keterlibatan pemegang kebijakan, termasuk pemerintah, dan dukungan masyarakat dibutuhkan agar anak dengan DM tipe 1 tertangani dengan baik.

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

et al. 2021

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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.

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Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study

Cited by 24 publications

References 32 publications

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

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

Diabetes Melitus Tipe-1 pada Anak: Situasi di Indonesia dan Tata Laksana

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

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