Background: DKA is the most serious life-threatening acute complication of T1D. Few data are available evaluating the possible role of anthropadiposity indexes in paediatric DKA in a selected population of prepubertal children. We aimed to identify the possible correlation between adiposity indexes and the presence and severity of DKA at T1D onset.
Methods: 195 prepubertal children (84Female/111Male) diagnosed between October 2010 and December 2018 were evaluated. Only children older than 2 years and without signs of pubertal development (thus younger than 11 years and 12 years for female and male, respectively) were included. Anthropometric measurements (height, height-SDS, weight, weight-SDS, BMI, BMI-SDS) were determined. Fasting blood samples were collected for glucose, venous pH, electrolytes, bicarbonate and glycosylated hemoglobin (HbA1c) measurement. The presence or absence of DKA was evaluated. According to pH values DKA severity was categorized as mild, moderate, and severe. A Spearman test was performed to evaluate any possible correlation between BMI-SDS values and the main variable of interest at onset. In order to characterize the effects of adiposity on the main variables of interest at onset, the study population was divided according to BMI-SDS into three tertile groups. The Kruskal-Wallis analysis was performed to evaluate differences across the tertile groups while the Mann-Withney test for the post hoc analysis.
Results: DKA at onset was reported in 36% of subjects (N=71/195). No difference in term of severity of DKA was documented between gender. We demonstrated a significant association between venous pH and BMI-SDS of children at the time of T1D diagnosis. HbA1c and age of onset for diabetes were inversely related to BMI-SDS. Glycaemia, HbA1c and pH values were significantly different across the three tertile groups. Glycaemia and HbA1c were significantly higher while the pH values significantly lower in first tertile of BMI-SDS than the third tertile. A progressive reduction in prevalence of DKA and its degree of severity was highlighted, with the increasing of the BMI-SDS tertiles. Children with lower BMI-SDS at the onset had an increased risk of severe DKA compared with those with a higher BMI-SDS.
Conclusions: Adiposity indexes correlate significantly and directly with the presence and degree of DKA at the onset of T1D in children. BMI-SDS values are directly correlated with pH values and inversely with HbA1c levels and an age of onset of DKA. With the increase of the BMI-SDS tertile, we observe a progressive reduction in the prevalence of DKA and its degree of severity.
19 Sep 2019 - 21 Sep 2019