Background: Diabetic ketoacidosis (DKA) is a severe and often the inaugural clinical manifestation of type 1 Diabetes (T1D). Diabetic nephropathy is one of the most devastating chronic complications of T1D and its early diagnosis is traditionally based on microalbuminuria.
Objective and hypotheses: The aim was to investigate the possible associations between the initial clinical manifestations and the chronic complications of T1D.
Method: Retrospective study of data acquisition on clinical manifestations during the long-term follow-up from the archives of the Diabetes Centre, Aghia Sophia Childrens Hospital from 1990 to 2013. We studied 567 individuals with T1D. Fifty-seven percent of these patients presented DKA at diagnosis. The 24-h urinary albumin excretion (UAE) ((nephelometer Turbox) Orion, Finland), was assessed in 196 of the 567 patients and microalbuminuria (MA) was defined with values between 30300 mg/day, measured on at least two measurements over a three-month period. Statistical analyses were performed using MedCalc statistical software.
Results: 30.6% of the patients examined for UAE, had microalbuminuria. The mean age of MA occurrence was 15.7 years and was not correlated with DKA. Kaplan-Meier survival curve showed a mean age of microalbuminuria 13.6 years for the patients who presented DKA at T1D onset, while the mean age for MA for those who had no DKA at onset was 17.4 years (P=0.024).
Conclusion: The mean age of microalbuminuria was significantly younger for those patients who initially presented DKA and this finding may reflect a genetic or environmental predisposition regarding the severity of the course of T1D. It has been supported that decreased C-peptide levels are associated with microvascular complications in T1D. Apparently, the early and severe pancreatic β-cells secretory exhaustion, results not only in DKA but may trigger the initiation of the pathophysiologic phenomena that lead to the microvascular complications at a younger age.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology