open access

Vol 9, No 5 (2020)
Research paper
Published online: 2020-09-23
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Clinical characteristics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes

Noha Arafa, Mona Mamdouh Hassan, Shimaa Atef, Asmaa Salah Eldin Fathallah, Amany Ibrahim
DOI: 10.5603/DK.2020.0042
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Clinical Diabetology 2020;9(5):286-292.

open access

Vol 9, No 5 (2020)
ORIGINAL ARTICLES
Published online: 2020-09-23

Abstract

Background. To compare the demographic and clinical characteristics of children with newly clinically diagnosed type 1 diabetes (T1DM) who presented with diabetic ketoacidosis (DKA) versus non DKA presentation and to identify the precipitating factor(s) related to progression to DKA. Methods. Over a 3 month period, 99 patients newly diagnosed with T1DM were recruited from Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Cairo University, with 53 patients presented with DKA and 46 were non DKA. Results. Polyuria, polydipsia, weight loss, polyphagia and nocturia were the most common symptoms preceding the diagnosis among the whole study group (93.8%, 92% and 80.8%, 76.8%, 46.5 % respectively) with no difference between DKA and non DKA groups. Delayed diagnosis occurred in 98.1% and 58.7% of DKA and non DKA groups respectively. In the DKA group the diagnosis of diabetes was missed in 69.8% and in 28.3% the initiation of insulin therapy was delayed despite diagnosis. Multivariate analysis performed to identify the most significant precipitating factor(s) associated with the development of DKA at diabetes diagnosis showed that delayed start of insulin therapy was the most significant factor (OR = 1.267, P value = 0.023). Conclusion. The prevalence of DKA is high among Egyptianchildren at diagnosis of type 1 diabetes. It is not only caused by misdiagnosis and mismanagement of diabetes, but also delayed initiation of insulin therapy in those diagnosed. This highlights the importance of increasing awareness concerning clinical features of diabetes in children and the urgency of insulin therapy among primary health care professionals and the community.

Abstract

Background. To compare the demographic and clinical characteristics of children with newly clinically diagnosed type 1 diabetes (T1DM) who presented with diabetic ketoacidosis (DKA) versus non DKA presentation and to identify the precipitating factor(s) related to progression to DKA. Methods. Over a 3 month period, 99 patients newly diagnosed with T1DM were recruited from Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Cairo University, with 53 patients presented with DKA and 46 were non DKA. Results. Polyuria, polydipsia, weight loss, polyphagia and nocturia were the most common symptoms preceding the diagnosis among the whole study group (93.8%, 92% and 80.8%, 76.8%, 46.5 % respectively) with no difference between DKA and non DKA groups. Delayed diagnosis occurred in 98.1% and 58.7% of DKA and non DKA groups respectively. In the DKA group the diagnosis of diabetes was missed in 69.8% and in 28.3% the initiation of insulin therapy was delayed despite diagnosis. Multivariate analysis performed to identify the most significant precipitating factor(s) associated with the development of DKA at diabetes diagnosis showed that delayed start of insulin therapy was the most significant factor (OR = 1.267, P value = 0.023). Conclusion. The prevalence of DKA is high among Egyptianchildren at diagnosis of type 1 diabetes. It is not only caused by misdiagnosis and mismanagement of diabetes, but also delayed initiation of insulin therapy in those diagnosed. This highlights the importance of increasing awareness concerning clinical features of diabetes in children and the urgency of insulin therapy among primary health care professionals and the community.

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Keywords

diabetic ketoacidosis, clinical characteristics, precipitating factors, children

About this article
Title

Clinical characteristics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes

Journal

Clinical Diabetology

Issue

Vol 9, No 5 (2020)

Article type

Research paper

Pages

286-292

Published online

2020-09-23

DOI

10.5603/DK.2020.0042

Bibliographic record

Clinical Diabetology 2020;9(5):286-292.

Keywords

diabetic ketoacidosis
clinical characteristics
precipitating factors
children

Authors

Noha Arafa
Mona Mamdouh Hassan
Shimaa Atef
Asmaa Salah Eldin Fathallah
Amany Ibrahim

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