ESPE Abstracts

Background: Diabetic ketoacidosis (DKA) is an acute complication of type 1 diabetes mellitus (T1DM) that can be fatal if not properly managed. DKA is a leading cause of mortality in these children, early recognition and prompt treatment should substantially reduce childhood mortality in children with T1DM.

Objective and hypotheses: We aimed to identify the risk factors and the most common clinical features of newly diagnosed diabetes in children, in addition to the factors related to delayed diagnosis or mismanagement in these children.

Method: Over a 3 month period, 99 patients newly diagnosed with T1DM; 53 (24 females and 29 males) of which had DKA and 46 (23 females and 23 males) were hyperglycemic with mean (S.D.) age of 6.89 (3.63) and 6.75 (3.53) were recruited from the inpatient department of the Diabetic, Endocrine and Metabolic Pediatric Unit (DEMPU), New Children Hospital, Cairo University.

Results: Polyuria, polydipsia and weight loss were the most common symptoms preceding the diagnosis (93.8%, 92% and 80.8% respectively). Delayed diagnosis occurred in 98.1% and 58.7% of DKA and hyperglycemic groups respectively. 69.8% of the DKA group were misdiagnosed as respiratory problems, gastroenteritis and urinary tract infections. Mismanagement was detected in 28.3% of DKA group. Multivariate analysis to predict the most significant risk factor(s) associated with the development of DKA at the time of diagnosis of T1DM showed delayed start of insulin therapy was the most significant risk factor associated with development of DKA with (OR=1.267, P value=0.023).

Conclusion: Increased awareness of the health care professionals to start insulin therapy appropriately and early is needed to reduce the frequency and severity of ketoacidosis.