Ketoacidosis in new-onset type 1 diabetes: did the severity increase during the COVID-19 pandemic?

Abstract Objectives Since the beginning of the COVID-19 pandemic, there has been a consistent decrease in the number of admissions to the emergency department, leading to a delay in the diagnosis of several pathologies. The time from onset of symptoms to the diagnosis of Type 1 diabetes is highly variable. This treatment delay can lead to the appearance of ketoacidosis. Methods Retrospective study of inaugural Type 1 diabetes cases, from March 2016 to March 2021. The pandemic group was considered between March 2020 to March 2021, and the remaining period was considered as pre-pandemic. Clinical variables were analysed: duration of symptoms, weight loss and value of ketonemia and glycated haemoglobin on admission. The mean differences were considered statistically significant at p<0.05. Results 103 inaugural episodes of Type 1 diabetes were registered. The pandemic group had a lower mean age when compared to pre-pandemic group, and 51.7% of the episodes had ketoacidosis with a higher relative risk of ketoacidosis and severe ketoacidosis, when compared the pandemic with pre-pandemic group, there was a longer symptom evolution time (34 vs. 20 days), greater weight loss occurred (9.5% vs. 6.3%), the pH and HCO3 − values were lower (7.30 vs. 7.36 and 16.43 vs. 20.71 mmol/L respectively) and ketonemia was higher (5.9 vs. 2.3 mmol/L). Conclusions The COVID-19 pandemic caused a delay in the diagnosis of Type 1 diabetes, greater length of disease, greater weight loss, higher ketonemia and lower pH and HCO3 −. There was greater ketoacidosis relative risk in pandemic group when compared to pre-pandemic group.

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Clinical profile of type 1 diabetes mellitus among children in eastern part of Nepal

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190691 ◽

2019 ◽

Vol 6 (2) ◽

pp. 583

Author(s):

Dipak Muktan ◽

Lisa Tamang (Ghising) ◽

Rupa Rajbhandari Singh

Keyword(s):

Diabetes Mellitus ◽

Weight Loss ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Glycosylated Hemoglobin ◽

Clinical Profile ◽

Duration Of Symptoms ◽

Family History Of Diabetes ◽

The Mean

Background: The objective of this study is to determine the clinical profile of Type 1 diabetes mellitus (T1DM) among children.Methods: Descriptive cross sectional study was conducted at B.P. Koirala institute of Health Sciences (BPKIHS), Dharan, Nepal, the eastern part of Nepal. A total of 42 diabetic children of less than 20 years old diagnosed with T1DM were included in the study. Data were collected via semi-structured interviews and medical records of patients attending diabetic clinic at the time of follow up.Results: The mean age at diagnosis of disease was 11.1±4.9 years. Polyuria 33 (78.6%) was found to be the commonest symptom followed by polydipsia 27 (64.3%), weight loss 23 (54.8%) and polyphagia 13 (30.9%). The mean duration of symptoms before diagnosis was 14.3±9.7 days. DKA was present in 25 (59.5%) children at the time of diagnosis. Mean Glycosylated hemoglobin (HbA1c) value was 10.6±2.7. Obesity was observed in 9 (21.4%) children. Nine (21.4%) children had family history of diabetes. In most of the cases, primary caregiver was mother, among them only 24 (57.2%) had formal education. Almost half of the caregivers were using FRIO, an insulin cooling case, for insulin storage.Conclusions: Polyuria was the most common presenting symptom followed by polydipsia, weight loss and polyphagia. Moreover, most of the children had landed up in diabetic keto-acidosis (DKA) at the time of diagnosis. Therefore, community awareness programs should be emphasized among parents and primary health care workers especially in rural areas regarding T1DM for early recognition and prompt treatment.

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Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

BMJ Open ◽

10.1136/bmjopen-2017-018094 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018094 ◽

Cited By ~ 13

Author(s):

Carine Sousa Andrade ◽

Guilherme Sousa Ribeiro ◽

Carlos Antonio Souza Teles Santos ◽

Raimundo Celestino Silva Neves ◽

Edson Duarte Moreira

Keyword(s):

Type 1 Diabetes ◽

Glycaemic Control ◽

Hba1c Level ◽

Glycated Haemoglobin ◽

Poor Adherence ◽

Adherence To Diet ◽

The Mean ◽

Lower Education ◽

Hba1c Levels

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.

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Clinical Profile of Type 1 Diabetes Mellitus in Saudi Children: a Hospital Based Study

Annals of King Edward Medical University ◽

10.21649/akemu.v22i4.1458 ◽

2016 ◽

Vol 22 (4) ◽

Cited By ~ 1

Author(s):

Muhammad Rafique ◽

Fouzia Ishaq ◽

Muhammad Khalid Masood ◽

Youssef Ali Mohamad Al-Qahtani ◽

Walaa Ibrahim Ahmed Assiri ◽

...

Keyword(s):

Diabetes Mellitus ◽

Weight Loss ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Middle Age ◽

Age Group ◽

Newly Diagnosed ◽

Duration Of Symptoms ◽

Presenting Symptoms

AbstractObjective: To determine the clinical characteristics of newly diagnosed type 1 diabetes mellitus (T1DM) in children under15 years of age. Cross sectional study conducted at Aseer Central Hospital Abha, South-western Saudi Arabia from June 2011 – May 2015.Patients and Methods: Study included 141 Saudi children, < 15 years old with newly diagnosed T1DM. The demographic and laboratory data were collected from file records. The patients were divided into younger (< 5 yr), middle (5 – 10 yr) and older (>10 – 15 yr) age groups. Data were analyzed by using SPSS version 16.Results: Age of 141 children at onset of T1DM (mean ± SD) was 6.5 ± 3.2 years and majority 62 (44%) belonged to middle age group. Older 43 (30.5%) age group had female predominance (2:1) (p < 0.0001). Diabetic ketoacidosis (DKA) (39%), obesity (11%) and male predominance (2.6:1) were found in younger 36 (25.5%) age group (p < 0.0001). Family history (F/Hx) of T1DM 29 (20.6%) and HbA1c (10.36 ± 1.8%) successively increased with advancing age of patients. Main presenting symptoms like polyuria (96%), polydipsia (85%), weight loss (62%), nocturia (47%), polyphagia (28%) and DKA (22%),were significantly more frequent in children with F/Hx of T1DM (p < 0.0001). Duration of symptoms at first presentation was 17.3 ± 10.7 days and daily insulin requirement was found 0.82 ± 0.2 units/ Kg.Conclusion: Polyuria, polydipsia, weight loss, noctu-ria and polyphagia were the main presenting symptoms and more frequent in middle age group children especially having F/Hx of T1DM. Under five years, obese and male children were found at higher risk for DKA development. Girls usually present late in adolescent age.

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Abdominal Pain and Weight Loss in New-Onset Type 1 Diabetes

Clinical Diabetes ◽

10.2337/diaclin.32.1.26 ◽

2014 ◽

Vol 32 (1) ◽

pp. 26-27

Author(s):

A. Aslam ◽

J. Byrne ◽

S. M. Rajbhandari

Keyword(s):

Weight Loss ◽

Type 1 Diabetes ◽

Abdominal Pain ◽

Onset Type ◽

New Onset

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Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1130933 ◽

2021 ◽

pp. 142-152

Author(s):

M. O. Ugege ◽

T. Yusuf

Keyword(s):

Type 1 Diabetes ◽

Abdominal Pain ◽

Diabetic Ketoacidosis ◽

Clinical Profile ◽

University Teaching ◽

Duration Of Symptoms ◽

Male Adolescents ◽

The Mean ◽

North Western

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). Few reports are available on DKA among children in North-west Nigeria. Objective: To describe the clinical profile and outcome of children managed for DKA in the Paediatric Endocrinology Unit of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-western Nigeria over a ten-year period (January 2011- December 2020). Methods: This was a retrospective review of the case records of all children managed for T1D between 2011 and 2020. Socio-demographic and clinical data of those with DKA were extracted and analysed using SPSS version 23. Results: Ten (62.5%) out of 16 children with T1D had DKA, comprising 8 males and 2 females; M: F ratio 4:1. Majority (90%) were adolescents aged 10-15years. The mean age ± standard deviation (SD) at diagnoses of T1D was 11.1 ± 3.14 years; DKA was the presenting manifestation of diabetes in 4 (40%) children, while 6(60%) were known diabetics with an average of 2-episodes per patient. The median duration of symptoms was 5 days (range 1-42 days). Abdominal pain (90%), polyuria (80%), fast breathing (70%), vomiting (70%), altered consciousness (70%), dehydration (100%) and Kussmaul respiration (70%) were the common presenting features. The mean blood glucose, bicarbonate and venous PH at admission were 23.28± 7.14 (range; 12.3-33.3) mmol/L, 14.1± 3.41 (10-21) mmol/L and 6.96± 0.06 (6.92-7.00) respectively. Co-morbid conditions included infections (80%), predominantly malaria (70%). There was no mortality. Conclusion: DKA is common in male adolescents, with good management outcome in our facility. Abdominal pain, dehydration, polyuria and Kussmaul respiration were the commonest presenting features. A high index of suspicion of DKA is recommended in any child, particularly, male adolescents with the aforementioned features. Effort should be made to confirm diagnosis and prompt treatment instituted.

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