scholarly journals Comparing Disease Severity: Diabetic Ketoacidosis in Local and Tourist Children With New-Onset Diabetes Mellitus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A450-A451
Author(s):  
Autumn Hinds ◽  
Mauri Carakushansky ◽  
Timothy Maul ◽  
Kenneth Alexander ◽  
Shilpa Gurnurkar
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Risk Factor ◽  
Diabetic Ketoacidosis ◽  
Illness Severity ◽  
Delay In Diagnosis ◽  
Central Florida ◽  
Onset Diabetes ◽  
Significant Difference ◽  
New Onset

Abstract Introduction: Approximately 30% of youth present with diabetic ketoacidosis (DKA) at the time of diagnosis of type 1 diabetes mellitus (DM). DKA severity can be mild to severe, impacting hospitalization duration as severity worsens, or even result in death. A delay in care from onset of symptoms results in greater illness severity. Travel has been a proposed risk factor for illness severity in general; one study identified ruptured appendicitis as a more frequent complication in children vacationing from their hometown. Identifying travel as a potential risk factor for severe DKA is necessary. There is no research highlighting the association between vacation and severity of DKA in new onset diabetics. Central Florida is one of the major vacation destinations and is home to a diverse population, so offers a unique study population. The goal of this novel study was to investigate the association between travel and severity of DKA in new onset diabetics. Methods: A retrospective chart review of children admitted to a children’s hospital in Central Florida with both new onset diabetes and DKA from October 2012-March 2020 was conducted. Patients that did not meet criteria for DKA based on venous pH (pH) < 7.3 or bicarbonate (HCO3) < 15 mmol/l were excluded. Patients were divided into two groups by primary residence: locals versus tourists. The severity of DKA was determined as either mild (pH < 7.3 or HCO3 10 to < 15), moderate (pH < 7.2 or HCO3 5–9), or severe (pH < 7.1 or HCO3 < 5), and compared between local versus tourist children with Chi-squared testing. Results: There was no significant difference in DKA severity between locals and tourists. 33% of local children presented in severe DKA compared to 29% of tourist children (p=0.809). The percentage of children overall presenting with moderate or severe DKA was about 70%. Gender and admission status had a statistically significant correlation to DKA severity. More females presented in severe DKA than males (56 % versus 44%, p=0.029), and patients transferred from an outside facility versus directly admitted from the emergency department had a higher percentage of severe DKA (76% versus 24%, p=0.002). Conclusion: This study is the first in the literature to report that travel does not seem to be a contributing risk factor to the severity of DKA. We did find that more than half of all new onset diabetics presented in moderate or severe DKA, indicating that there is currently a frequent delay in diagnosis of children with new onset diabetes. A higher rate of severe DKA was noted in patients transferred from an outside facility versus children admitted directly to the ICU from our emergency department, which may likely be due to challenging access to a specialty pediatric hospital among patients living in remote areas. We propose that future studies investigate this relationship further to guide interventions that can significantly reduce the rate of severe DKA on presentation.

New-onset diabetes mellitus presenting with diabetic ketoacidosis after pediatric liver transplantation

2009 ◽  
Vol 13 (5) ◽  
pp. 536-539 ◽  
Author(s):  
Seyed Mohsen Dehghani ◽  
Saman Nikeghbalian ◽  
Ahad Eshraghian ◽  
Mahmood Haghighat ◽  
Mohammad Hadi Imanieh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Liver Transplantation ◽  
Diabetic Ketoacidosis ◽  
Pediatric Liver Transplantation ◽  
Pediatric Liver ◽  
Onset Diabetes ◽  
New Onset Diabetes Mellitus ◽  
New Onset

scholarly journals Pembrolizumab-Induced Diabetes Mellitus Presenting as Diabetic Ketoacidosis in a Patient With Metastatic Colonic Adenocarcinoma

2020 ◽  
Vol 8 ◽  
pp. 232470962095133
Author(s):  
Asim Kichloo ◽  
Michael S. Albosta ◽  
Shane McMahon ◽  
Kimberly Movsesian ◽  
Farah Wani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
T Cells ◽  
T Cell ◽  
Insulin Therapy ◽  
Diabetic Ketoacidosis ◽  
T Cell Activation ◽  
Immune Checkpoint ◽  
Colonic Adenocarcinoma ◽  
Onset Diabetes ◽  
New Onset

Immunotherapy drugs are gaining popularity in the treatment of certain malignancies due to the success of these agents in recent clinical trials. Pembrolizumab is an immune checkpoint inhibitor that acts via binding to programmed cell death 1 (PD-1) receptors on T-cells, allowing for the constitutive activation of T-cells to fight malignant tumor cells. Immune checkpoint molecules such as PD-1 act to inhibit T-cell function, promoting tolerance to self-antigens. Inhibition of these molecules may lead to increased T-cell activation against cancer cells, but also against healthy tissue, leading to the side effects of these medications known as immune-related adverse events. In this article, we present the case of a 77-year-old female with a history of metastatic colonic adenocarcinoma presenting with new-onset diabetes mellitus and diabetic ketoacidosis in the setting of receiving pembrolizumab chemotherapy. Our patient was treated with hydration, insulin therapy, and management of her electrolytes, ultimately being discharged with the need for home insulin therapy to manage her new-onset diabetes. There are no current guidelines for the management or surveillance of patients receiving pembrolizumab chemotherapy, and further research should be done to determine which patients are at highest risk to developing this rare but potentially lethal side effect.

scholarly journals New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Nabila Chekhlabi ◽  
Amal Haoudar ◽  
Nadia Echcharii ◽  
Said Ettair ◽  
Nezha Dini
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Asymptomatic Infection ◽  
Acute Onset ◽  
Thoracic Imaging ◽  
Intravenous Insulin ◽  
Insulin Requirements ◽  
Onset Diabetes ◽  
Potential Trigger ◽  
New Onset

Background and Aims. There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. Results. Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. Conclusion. COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

scholarly journals New-Onset Diabetes Mellitus in Patients with Idiopathic Membranous Nephropathy Undergoing Tacrolimus and Low-Dose Corticosteroid Therapy

2019 ◽  
Vol 44 (6) ◽  
pp. 1352-1362 ◽  
Author(s):  
Lina Shao ◽  
Juan Jin ◽  
Binxian Ye ◽  
Baihui Xu ◽  
Yiwen Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Factor ◽  
Corticosteroid Therapy ◽  
Low Dose ◽  
Significant Difference ◽  
Dose Corticosteroid ◽  
New Onset Diabetes Mellitus ◽  
New Onset

Background: Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. Although various studies have demonstrated the efficacy of tacrolimus combined with corticosteroids for treating IMN, both tacrolimus and corticosteroids have been shown to be diabetogenic, particularly following organ transplantation. Furthermore, the frequency and risk factors for new-onset diabetes mellitus (NODM) in IMN patients treated with tacrolimus plus low-dose corticosteroids remain unclear. Objectives: To evaluate the incidence of NODM in IMN patients undergoing tacrolimus plus low-dose corticosteroid therapy and to confirm the risk factors for NODM development. Methods: This retrospective study recruited 72 eligible patients with biopsy-proven IMN from our center, between September 2013 and June 2018. All subjects were treated with tacrolimus plus low-dose corticosteroids for a minimum of 3 months. The primary outcome was NODM development during the follow-up period. The secondary outcome was complete or partial remission. Patients were divided into 2 groups: patients with NODM (NODM group) and those without NODM (No-NODM group). Demographic and clinical data at baseline and follow-up were assessed. Results: During follow-up, 31 of the 72 patients developed NODM (43.0%). The median time to occurrence was 3 months after treatment initiation. NODM patients were significantly older (median age 59 vs. 40 years) than No-NODM patients. Baseline fasting blood glucose levels were slightly higher in the NODM group; however, the difference was not significant (p = 0.07). Older age was an independent risk factor for NODM (OR 1.73 and 95% CI 1.20–2.47, p = 0.003). Overall kidney remission rates were 80.6%. There was no significant difference in remission rate between groups. There was a significant difference in development of pulmonary infection, which occurred in 7 NODM patients and only in 1 No-NODM patient (p = 0.018). IMN reoccurred in 5 NODM patients but only 1 No-NODM patient. Conclusions: Tacrolimus plus low-dose corticosteroid therapy was an efficient treatment for IMN; however, it was accompanied by increased NODM morbidity, which should be considered serious, due to the increased risk of life-threatening complications. Increasing age was a major risk factor for NODM in IMN patients treated with tacrolimus plus low-dose corticosteroid therapy.

New-Onset Diabetes Mellitus and Diabetic Ketoacidosis Associated With Olanzapine Treatment

1999 ◽  
Vol 40 (5) ◽  
pp. 438-443 ◽  
Author(s):  
Lee E. Goldstein ◽  
Jonathan Sporn ◽  
Susan Brown ◽  
Helen Kim ◽  
Joan Finkelstein ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Olanzapine Treatment ◽  
Onset Diabetes ◽  
New Onset Diabetes Mellitus ◽  
New Onset

scholarly journals Vesetranszplantáció utáni szénhidrátanyagcsere-változások és annak hatásai a cardiovascularis rizikóra

2017 ◽  
Vol 158 (38) ◽  
pp. 1512-1516
Author(s):  
Bernadett Borda ◽  
Edit Szederkényi ◽  
Zoltán Hódi ◽  
Aurél Ottlakán ◽  
Viktor Szabó ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Baseline Data ◽  
Diabetic Patients ◽  
Ischemic Time ◽  
Heart Score ◽  
Onset Diabetes ◽  
Significant Difference ◽  
New Onset Diabetes Mellitus ◽  
New Onset

Abstract: Introduction: Cardiovascular disease is the major cause of deaths after transplantation, with diabetes mellitus being the main risk factor in development. Aim: The aim of our study was to assess the prevalence of new onset diabetes mellitus in connection with the cardiovascular risk predicted by the HEART Score. Method: 44 patients were involved in our study; after overview of baseline data, OGTT was performed, followed by patient classification into the following groups: normal, impaired fasting glucose/impaired glucose tolerance, and new onset diabetes mellitus. Insulin resistance and kidney function were also assessed. Results: Concerning baseline data, cold ischemic time (p = 0.016), body weight (p = 0.035), BMI (p = 0.025), and HbA1C (p = 0.0024) proved to be significantly different between normal and diabetic patients. Significant difference was found based on HOMA IR between the two groups 1.69±0.51 vs 6.46±1.42; p = 0.0017). Based on the HEART Score, patients with new onset diabetes mellitus were put into Group 3, which also reflects the risk which diabetes carries for the development of cardiovascular diseases. Conclusion: Cardiovascular risk can be decreased with increased allograft survival by early diagnosis and management of diabetes. Orv Hetil. 2017; 158(38): 1512–1516.

Sign in / Sign up

Export Citation Format

Share Document