Type 1 diabetes (T1DM) in childhood is a highly prevalent disease, with incidence oscillating around 17.6/100000. However, incidence is higher in some communities (25.5/100,000), as it is in the case that concerns us. Diabetic ketoacidosis (DKA) is a complication usually recorded in 2540% of cases but has been as high as 55% in studies of children under 5 years old. (T1DM) is an associated autoimmune disease to other precursor autoimmune pathologies.
Objective: To compare the clinical, epidemiological and associated comorbidities in patients with type 1 DM. Establish differences between (DKA) with and without onset, as well as severity of said (DKA).
Material and method: Observational, descriptive and analytical retrospective study of patients diagnosed with (T1DM), between January 2013 and December 2017. The variables sex, age, HBA1c, Insulin, C-peptide, severity of DKA, place of origin, levels of 25-OH-Vitamin D, season, autoimmunity, breastfeeding, diseases associated with the onset, establishing two periods to compare 20132015, versus 20162017. We have stratified the DKA according to age groups: 05 years, 510 years, 1014 in order to analyze if the incidence was higher in children under 5 years, as reflected in the literature. Data was analyzed through SSPS20.0.
Results: 101 children were diagnosed, the population is parity with respect to sex (53.5% F vs 46.5% M). The mean age was 8.03 years, DKA (8.1±3.8) versus NO DKA (8.2±3.7). The average HbA1C was 10.98%, there were no significant difference between time periods, neither between patients with or without DKA. 70% of cases of severe DKA in 20162017 were older than 5 years. In the first period, 68.9% were referred from ambulatory, versus 43% in the second period (P<0.05). Significant differences were observed in patients who were referred from the emergency department between both periods 13.3% versus 30%. There were significant differences in patients with KAD referred from ambulatory in the second period 37.8%, versus 55% in the first period (P<0.05). They presented diabetes antibodies (positive antiGAD 31.6%, positive ICA 8.9% and positive Antithyrosine-phosphatase 36.7%, and Antiinsulin 50%. The average evolution to diagnosis was 2.8±1.2 weeks. There were significant differences in both groups of patients (with and without KAD) in both periods, related with the season of the year at diagnosis, autoinmunity, coeliac disease and breastfeeding (P<0.05).
Conclusions: We believe that the promotion of diabetological education programs, awareness and clinical recognition, is fundamental since it would allow early diagnosis and corresponding decrease of the number of serious complications.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology