Background: Diabetic ketoacidosis (DKA) is the most serious acute complication of type 1 Diabetes mellitus (T1DM). It is important to know the factors associated with the development of DKA and elaborate preventive strategies to reduce their prevalence.
Objective and hypotheses: To identify DKA predictive risk factors in the initial presentation of T1DM in children and adolescents.
Method: We conducted a retrospective study, by analyzing the medical records of children/adolescents diagnosed with T1DM between 2000 and 2015, followed in our hospital. We have made a descriptive analysis of demographic and clinical variables, the occurrence of DKA in the initial presentation and a comparative analysis between the groups with and without DKA. Statistical analysis was performed with SPSS.
Results: A total of 205 children/adolescents were diagnosed, but 50 were excluded due to incomplete data. Of the 155 evaluated, the majority were male (58.1%), with an average age 7.8±4.1 years. In the inaugural episode of T1DM 61 cases (39.9%) of DKA were documented (19 cases (12.4%) had severe DKA). The most common symptoms were polyuria (96.5%), polydipsia (90.3%) and weight loss (61.1%). The DKA was significantly more frequent in cases with a duration of symptoms ≥15 days (46.0% vs 28.3%; P<0.05, OR 2.2), initial HbA1c ≥10% (52.2% vs 8.0%; P<0.001, OR 12.5) and C-peptide <1.0 ng/ml (40.6% vs 5.9%; P<0.05 OR 10.9). The DKA was less frequent in the presence of family history of T1DM (17.4% vs 42.5%; P<0.05, OR 0.285). We did not observe differences in the occurrence of DKA in relation to the following variables: age at diagnosis, gender, parents education level, month of diagnosis, presenting symptoms and presence of autoantibodies.
Conclusion: The DKA as the initial presentation of T1DM in pediatric population was high, above the international average that is around 30%. Were identified as risk factors: symptoms that persist longer than 15 days, initial HbA1c ≥10% and C-peptide <1.0 ng/ml and as a protective factor the family history of T1DM. It is necessary to strengthen the public education in order to reduce the time between the onset of symptoms and the diagnosis of T1DM.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology