open access

Vol 7, No 6 (2018)
ORIGINAL ARTICLES
Published online: 2019-01-07
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Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Elżbieta Niechciał, Bogda Skowrońska, Michał Michalak, Piotr Fichna
DOI: 10.5603/DK.2018.0029
·
Clinical Diabetology 2018;7(6):272-278.

open access

Vol 7, No 6 (2018)
ORIGINAL ARTICLES
Published online: 2019-01-07

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 symp­toms’ 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.

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 symp­toms’ 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.

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Keywords

children, diabetic ketoacidosis, type 1 diabetes onset, autoimmunity, autoantibody against zinc transporter 8

About this article
Title

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

Journal

Clinical Diabetology

Issue

Vol 7, No 6 (2018)

Pages

272-278

Published online

2019-01-07

DOI

10.5603/DK.2018.0029

Bibliographic record

Clinical Diabetology 2018;7(6):272-278.

Keywords

children
diabetic ketoacidosis
type 1 diabetes onset
autoimmunity
autoantibody against zinc transporter 8

Authors

Elżbieta Niechciał
Bogda Skowrońska
Michał Michalak
Piotr Fichna

References (27)
  1. Aldworth J, Chris Pa, Jacobs E. IDF Diabetes Atlas Eighth Edition : 2017.
  2. Menke A, Orchard TJ, Imperatore G, et al. The prevalence of type 1 diabetes in the United States. Epidemiology. 2013; 24(5): 773–774.
  3. Dabelea D, Mayer-Davis EJ, Saydah S, et al. SEARCH for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014; 311(17): 1778–1786.
  4. Editor?s Note. Pediatric Diabetes. 2007; 8(s8): 6–6.
  5. Stanescu DE, Lord K, Lipman TH. The epidemiology of type 1 diabetes in children. Endocrinol Metab Clin North Am. 2012; 41(4): 679–694.
  6. Rewers M, Stone RA, LaPorte RE, et al. Poisson regression modeling of temporal variation in incidence of childhood insulin-dependent diabetes mellitus in Allegheny County, Pennsylvania, and Wielkopolska, Poland, 1970-1985. Am J Epidemiol. 1989; 129(3): 569–581.
  7. Usher-Smith JA, Thompson M, Ercole A, et al. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia. 2012; 55(11): 2878–2894.
  8. Usher-Smith JA, Thompson MJ, Sharp SJ, et al. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ. 2011; 343(jul07 1): d4092–d4092.
  9. Lee HJ, Yu HW, Jung HW, et al. Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents. J Korean Med Sci. 2017; 32(2): 303–309.
  10. Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord. 2013; 12(1): 47.
  11. Pawłowicz M, Birkholz D, Niedźwiecki M, et al. Difficulties or mistakes in diagnosing type 1 diabetes mellitus in children? The consequences of delayed diagnosis. Pediatr Endocrinol Diabetes Metab. 2008; 14(1): 7–12.
  12. Neu A, Willasch A, Ehehalt S, et al. DIARY Group Baden-Wuerttemberg. Ketoacidosis at onset of type 1 diabetes mellitus in children--frequency and clinical presentation. Pediatr Diabetes. 2003; 4(2): 77–81.
  13. Piva J, Czepielewski M, Garcia P, et al. Current perspectives for treating children with diabetic ketoacidosis. Jornal de Pediatria. 2007; 0(0).
  14. Wolfsdorf J, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes. 2018; 19: 155–177.
  15. Abdul-Rasoul M, Habib H, Al-Khouly M. 'The honeymoon phase' in children with type 1 diabetes mellitus: frequency, duration, and influential factors. Pediatr Diabetes. 2006; 7(2): 101–107.
  16. Fredheim S, Johannesen J, Johansen A, et al. Danish Society for Diabetes in Childhood and Adolescence. Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels. Diabetologia. 2013; 56(5): 995–1003.
  17. Nwosu BU, Zhang Bo, Ayyoub SS, et al. Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis. PLoS One. 2018; 13(5): e0196912.
  18. Olak-Białoń B, Deja G, Jarosz-Chobot P, et al. [The occurrence and analysis of chosen risk factors of DKA among children with new onset of DMT1]. Pediatr Endocrinol Diabetes Metab. 2007; 13(2): 85–90.
  19. Szypowska A, Ramotowska A, Grzechnik-Gryziak M, et al. High Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes. Journal of Diabetes Research. 2016; 2016: 1–5.
  20. Jarosz-Chobot P, Polanska J, Szadkowska A, et al. Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia. 2010; 54(3): 508–515.
  21. Jarosz-Chobot P, Deja G, Polanska J. Epidemiology of type 1 diabetes among Silesian children aged 0-14 years, 1989-2005. Acta Diabetol. 2010; 47(1): 29–33.
  22. Szalecki M, Wysocka-Mincewicz M, Ramotowska A, et al. Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study. Diabetes/Metabolism Research and Reviews. 2017; 34(2): e2962.
  23. Lombardo F, Valenzise M, Wasniewska M, et al. Two-year prospective evaluation of the factors affecting honeymoon frequency and duration in children with insulin dependent diabetes mellitus: the key-role of age at diagnosis. Diabetes Nutr Metab. 2002; 15(4): 246–251.
  24. Neylon OM, White M, O´Connell MA, et al. Insulin-dose-adjusted HbA1c-defined partial remission phase in a paediatric population-when is the honeymoon over? Diabetic Medicine. 2013; 30(5): 627–628.
  25. Wenzlau JM, Juhl K, Yu L, et al. The cation efflux transporter ZnT8 (Slc30A8) is a major autoantigen in human type 1 diabetes. Proc Natl Acad Sci U S A. 2007; 104(43): 17040–17045.
  26. Cizza G, Brown RJ, Rother KI. Rising incidence and challenges of childhood diabetes. A mini review. J Endocrinol Invest. 2012; 35(5): 541–546.
  27. Niechciał AE, Fichna BP. New-Onset Diabetes in Obese Adolescents ? Type 1 or Type 2 Diabetes? Comparative Cases Report. Journal of Diabetes & Metabolism. 2012.

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