Frequency of Ketoacidosis and Associated Risk Factors at the Onset of Type 1 Diabetes Mellitus in Children and Adolescents
Iraqi Postgraduate Medical Journal,
2021, Volume 20, Issue 3, Pages 302-309
Diabetic Ketoacidosis (DKA) is the most serious acute Complication of type 1diabetes mellitus and the leading cause of morbidity and mortality in children. It still carries high incidence rate at time of diagnosis.
Study design: Hospital-based cross-sectional observational study conducted at Children Welfare Teaching Hospital /Medical City /Baghdad; including the admitted patients in ER.
To identify the frequency of ketoacidosis and associated risk factors at the onset of Type 1 Diabetes Mellitus in children and adolescents.
The demographic, clinical manifestation, laboratory data of 69 patients presented with DKA at the disease onset out of total 144 patients who were diagnosed as Type 1Diabetes Mellitus; during a one-year period from 1st of September 2017 to 31th of August 2018. Age distribution was categorized into three groups: 1- 5 years, <5 years, >10 years. DKA was defined as blood glucose ≥200 mg/ dl; blood PH < 7.3; associated with ketonuria and glucosuria.
Of 69/144 patients (47.9%) presented with diabetic ketoacidosis at disease onset; 41 patients (59.4%) were females which was significant (P value 0.045); Mean age at diagnosis was 7.5± 3.4 years: with highest frequency (43.5%) in age group >5 years but (50%) of severe DKA patients were involved in younger age group ≤ 5 years. Family history of diabetes was found in 11 (15.9%) patients. Majority of primary caregivers had a low academic achievement just14 (20.3%) of them had higher education.
The frequency of childhood DKA at the disease onset was still high. Girls had a higher rate of occurrence. Younger age is associated with more severe DKA. Family history of diabetes and education level of the parents did not affect the frequency of DKA.
- Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37:S81.
- Svoren B. Jospe N. diabetes mellitus in children: Kliegman R., Stanton B.,Schor, N. Nelson text book of pediatrics .20th edition.2016 Volume 2:2760-2790
- Patterson CC, Dahlquist GG, Gij ˝ur˝ us E, Green A,Solt´esz G; the EURODIAB Study Group. Incidence trends for childhood Type 1 Diabetes in Europe during 1989-2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009:373: 2027–33.
- Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, La Porte R,Tuomilehto J; for the Diabetes Mondiale (DIAMOND) Project Group. Incidence of childhood type 1 diabetes worldwide. Diabetes Care 2000: 23:1516–26.
- Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre pros prospective registration study. Lancet 2009; 373:2027–33.
- Harjutsalo V, Reunanen A, Tuomilehto J. childhood Diabetes mellitus type 1. Diabet Med 2006; 55:1517–24.
- Van Belle T. Coppieters K. Von Herrath M. Type 1 diabetes: etiology, immunology, and therapeutic strategies. Physiological Reviews. 2011;91: 79–118.
- Jayashree M. Singhi S. Diabetic ketoacidosis: Predictors of outcome in apaediatric intensive care unit of a developing country. Pediatr Crit Care Med. 2004;5: 427-33. doi: 10.1542/ peds.2007-1105.
- Mark A. Sperling, Wiliam V. Tamborlane, Tadej Battelino, Stuart A. Weunzimer, Moshe Phillip. Diabetes Mellitus, in: Pediatric Endocrinology, 4th edition. Elsevier, Saunders 2014: 846-900.
10. Rewers, A.; Klingensmith, G.; Davis, C.; Petitti, D.B.; Pihoker, C.; Rodriguez, B, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus inyouth: The search for diabetes in youth study. Pediatrics 2008, 121, E1258–E1266.
11. Kitabchi AE, Umpierrez GE, Murphy MB, et al.: Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001; 24:131–53.
12. Wolfsdorf, J., Glaser, N., & Sperling, M. for the American Diabetes Association. Diabetes ketoacidosis in infants, children and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1150–59.
13. Wolfsdorf, J., Craig, M. E., Daneman, D., et al.. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes, 2009;10: 118–33.
14. Westphal SA. Am J Med 1996; 101:19–24.
15. Didem Ardicli*, Nurgun K., Ayfer A., Alev O. and Nazli G. Clinical characteristics of type 1 diabetes over a 40 year period in Turkey: secular trend towards earlier age of onset. J Pediatr Endocr Met 2014; 27: 635–41.
16. Kalliora MI, Vazeou A, Delis D, Bozas E, Thymelli I et al.Seasonal variation of type 1 diabetes mellitus diagnosis in Greek children. Hormones 2011; 10:67–71.
17. Karges B, Neu A, Hofer SE, Rosenbauer J, Kiess W, et al. [Frequency and influencing factors of ketoacidosis at diabetes onset in children and adolescents – a long-term study between 1995 and 2009]. Klin Padiatr 2011; 223:70–3 (in German).
18. Hekkala A, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 diabetes in children in northern Finland: temporal changes over 20 years. Diabetes Care 2007; 30:861–66.
19. Razavi Z. Frequency of Ketoacidosis in Newly Diagnosed Type 1 Diabetic Children. OMJ 2010; 25:114-17.
20. Xin Y. Yang M. Chen X. Tong Y. Zhang L. Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China. Journal of Paediatrics and Child Health 2010; 46:171–75.
21. Moltchanova EV, Schreier N, Lammi N, Karvonen M. Seasonal variation of diagnosis of type 1 diabetes mellitus in children Worldwide. Diabet Med 2009; 26:673–78.
22. Waldhor T, Schober E, Rami B, Tuomilehto J. The prevalence of IDDM in the first degree relatives of children newly diagnosed with IDDM in Austria– a population-based study. Austrian Diabetes Incidence Study Group. Exp Clin Endocrinol Diabetes 1999; 107:323–27.
23. Habeb AM, Al-Magamsi MS, Halabi S, Eid IM, Shalaby S, et al. High incidence of childhood type 1 diabetes in Al-Madinah, North West Saudi Arabia (2004-2009). Pediatr Diabetes 2011; 2:676–81.
24. Hekkala A, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 Diabetes in children in northern Finland: temporal changes over 20 years. Diabetes Care 2007; 30:861–66.
25. Neu A, Willasch A, Ehehalt S, Hub R, Ranke MB, et al. Ketoacidosis at onset of type 1 diabetes mellitus in children – frequency and clinical presentation. Pediatr Diabetes 2003; 4:77–81.
26. Sadauskaite-Kuehne V, Samuelsson U, Jašinskien E et al. Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition. Diabetes Res Clin Pract 2005; 68:247–54.
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