ESPE Abstracts

Background and Aims: Initial presentation of type 1 diabetes (T1D) is associated with different level of diabetic ketoacidosis (DKA). Four pancreatic islet cell autoantibodies (Abs) mostly associate with T1D - glutamic acid decarboxylase antibodies (anti-GAD65), tyrosine phosphatase antibodies (IA 2-Ab), insulin autoantibody (anti-IAA) and zinc transporter 8 antibody

Aim: To evaluate the prevalence of DKA, the frequency of positive islet autoantibodies and the laboratory differences between patients with and without DKA at T1D diabetes onset in youth at a Specialised diabetes center for a period of four years (March 2019 - March 2023).

Methods: A total of 160 newly-diagnosed patients were enrolled in the study. Demographic and laboratory data was collected. Participants were tested for anti-GAD65, anti-IA2 and anti-IAA by ELISA.

Results: The mean age of the participants was 9.0±4.3 years (57% boys). At the onset of T1D, 44.3% were with initial DKA while 16.9% were with severe DKA. In the group without DKA the prevalence of boys is significantly higher compared to those without DKA (64% vs 48%, P=0.002). The participants with DKA were younger (8.2±4.3 vs 9.6±4.3 years, P=0.04) with significantly higher levels of initial blood glucose levels (23.4±7 vs 18.3±9.1 years, P<0.001) and HbA1c (12.2±2.3 vs 11±2.4%, P<0.001). C-peptide levels were significantly higher in the patients without DKA: 0.84 vs 0.40 ng/ml, P<0.001. Weak significant correlations were found between the severity of DKA and age (r= -0.143, P<0.03), HbA1c (r= 0.26, P=0.001) and C-peptide levels (r= -0.204, P=0.012). At diagnosis, 81.6% were with at least one positive diabetes related autoantibody. At the onset of T1D, 6.1% of patients were with 3 positive Abs, 41.5% had 2 Abs and 34% had 1 positive Ab. Of all positive, 84.1% had anti-GAD65, followed by 62.5% anti-IA2, and 19.1% anti-IAA positive, resp. (P<0.01). Of all participants, 81.6% had low level of C-peptide which correlates with age (r= 0.356, P<0.0001)

Conclusions: Initial DKA in our study is associated with younger age, higher initial BGL and HbA1c levels as well as lower C-peptide levels. Incidence of DKA among youth and most frequent diabetes associated antibodies in new onset T1D are similar as reported worldwide, and with no relation with initial DKA.