Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes

ObjectiveTo explore the relationship between family history of diabetes and frequency of diabetic ketoacidosis (DKA) at diagnosis and to analyze the possible association between HLA genotypes and DKA.Design and methodsWe recruited 510 children and adolescents aged <17 years with type 1 diabetes (T1D) and collected information on first-degree relative (FDR) history of T1D. DKA and severe DKA were defined as blood pH <7.30 and <7.10 at diabetes onset respectively. Risk categories for developing T1D were determined according to various HLA DQA1-DQB1 haplotype combination genotypes.ResultsThe frequency of DKA and severe DKA at diagnosis was 34.7 and 7.2% respectively. DKA was more frequent in younger patients (<2 years (60.0%; P<0.001)) and occurred less in children with at least one FDR affected by T1D (13.0 vs 37.4%, P<0.001). The logistic regression showed that age at diagnosis (<2 years) and increased HLA-associated risk genotypes were independent predictors of DKA (P<0.01, odds ratio (OR)=1.068 (95% confidence interval (CI) 1.021–1.117); P<0.05, OR=1.606 (95% CI 1.034–2.475)). Introducing the presence of T1D in at least one FDR in the logistic model, a significant association between DKA and age at diagnosis (<2 years; P<0.01, OR=1.072 (95% CI 1.024–1.123)) and absence of FDRs with T1D (P=0.001, OR=4.287 (95% CI 1.770–10.383)) was found, but no more with increased HLA-associated risk genotype (P=0.06, OR=1.550 (95% CI 0.992–2.423)).ConclusionsHLA-associated high-risk genotypes are associated with a high chance of presenting DKA at diabetes onset. However, having at least one FDR with T1D reduced the risk of DKA regardless of HLA genotype.

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Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis

Acta Endocrinologica ◽

10.1530/eje-11-0376 ◽

2011 ◽

Vol 165 (5) ◽

pp. 813-817 ◽

Cited By ~ 23

Author(s):

Anne Hekkala ◽

Jorma Ilonen ◽

Mikael Knip ◽

Riitta Veijola ◽

_ _

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Family History ◽

Diabetic Ketoacidosis ◽

Family History Of Diabetes ◽

Hla Dr ◽

Hla Genotypes ◽

History Of

ObjectiveOur purpose was to assess whether family history of diabetes or the HLA-DR-DQ genotype of the index case was associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of childhood type 1 diabetes.Patients and methodsThe study cohort comprised 1518 children aged <15 years and diagnosed with type 1 diabetes in Finland in 2002–2005. Family history of type 1 and type 2 diabetes among first-degree relatives (FDRs) and grandparents was assessed at diagnosis. HLA-DR-DQ genotypes were analysed using time-resolved fluorometry.ResultsIn total, 12.6 and 1.7% of children had at least one FDR affected with type 1 or type 2 diabetes, respectively, and 6.6 and 34.8% had at least one grandparent with type 1 or type 2 diabetes. DKA (pH <7.30) occurred less frequently in children having a type 1 diabetes affected FDR (7.4 vs 20.5%, P<0.001). Type 2 diabetes among the parents or grandparents had no such effect. Lower risk HLA genotypes were observed to predispose to DKA (P<0.024). In a logistic regression analysis, the risk of DKA was independently associated with the absence of a family member affected by type 1 diabetes, the presence of a low-risk HLA genotype and older age at diagnosis (odds ratio 3.23, 1.45 and 1.07 respectively).ConclusionThe presence of type 1 diabetes in an FDR is associated with an decreased risk of DKA at diagnosis. The rate of DKA seems to be higher in children with lower HLA-conferred risk for type 1 diabetes.

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Birth weight, family history of diabetes and diabetes onset in schizophrenia

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001036 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001036 ◽

Cited By ~ 2

Author(s):

Emilio Fernandez-Egea ◽

Ryan Walker ◽

Hisham Ziauddeen ◽

Rudolf N Cardinal ◽

Edward T Bullmore

Keyword(s):

Birth Weight ◽

Family History ◽

Cox Regression ◽

Family History Of Diabetes ◽

Clozapine Treatment ◽

Diabetes Onset ◽

Length Of Treatment ◽

Glucose Dysregulation ◽

History Of ◽

Design And Methods

IntroductionThe prevalence of diabetes in schizophrenia is twice that in the general population, but there are few reliable predictors of which individuals will develop glucose dysregulation.ObjectiveTo test if abnormal birth weight (either too low or too high) and parental diabetes, both variables that can be ascertained in the clinic, can predict diabetes onset in patients with schizophrenia.Research design and methodsElectronic records of a cohort of 190 clozapine-treated patients (37% treated for more than 20 years) and Cox regression survival analysis (with any type of glucose dysregulation as the event) to account for differences in length of treatment before the event and age at clozapine treatment initiation.ResultsAge at clozapine initiation (Exp(B)=1.098; p<0.001), family history of diabetes (Exp(B)=2.299; p=0.049) and birth weight2 (Exp(B)=0.999; p=0.013) were significant predictors of glucose dysregulation onset, while gender was not (Exp(B)=0.1.350; p=0.517). Among individuals with 10 years of follow-up, 80% of those with both abnormal birth weight and a family history of diabetes developed diabetes compared with 56% with only abnormal birth weight, 40% with only a family history of diabetes and 20% in those with neither.ConclusionsSince 48% of cases had at least one risk factor and 6% had both risk factors, there is a substantial proportion of patients for whom preventive strategies could be implemented.

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FAMILY HISTORY OF DIABETES IS ASSOCIATED WITH INCREASED RISK OF RECURRENT DIABETIC KETOACIDOSIS IN PEDIATRIC PATIENTS

Endocrine Practice ◽

10.4158/ep-2019-0351 ◽

2020 ◽

Vol 26 (3) ◽

pp. 305-311

Author(s):

Janaki D. Vakharia ◽

Sungeeta Agrawal ◽

Janine Molino ◽

Lisa Swartz Topor

Keyword(s):

Diabetes Mellitus ◽

Family History ◽

Diabetic Ketoacidosis ◽

Pediatric Patients ◽

Incidence Rate Ratio ◽

Family History Of Diabetes ◽

Increased Risk ◽

History Of

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus

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A family history of diabetes determines poorer glycaemic control and younger age of diabetes onset in immigrants from the Middle East compared with native Swedes

Diabetes & Metabolism ◽

10.1016/j.diabet.2014.08.003 ◽

2015 ◽

Vol 41 (1) ◽

pp. 45-54 ◽

Cited By ~ 11

Author(s):

L. Bennet ◽

U. Lindblad ◽

P.W. Franks

Keyword(s):

Family History ◽

Middle East ◽

Glycaemic Control ◽

Family History Of Diabetes ◽

Diabetes Onset ◽

Younger Age ◽

History Of

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Diabetes onset before age 40: more and more often it is type 2 diabetes

ABOUTOPEN ◽

10.19156/abtpn.2018.0058 ◽

2018 ◽

Vol 4 (1) ◽

pp. 126-128

Author(s):

Viola Sanga

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Family History ◽

Young Age ◽

Family History Of Diabetes ◽

Diabetes Onset ◽

History Of

An increase in the appearance of diabetes mellitus at young age is observed, and not necessarily type 1 diabetes is involced. We report the case of a 35-year-old patient, with a family history of diabetes, with type 2 diabetes at onset (Diabetology).

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Oesophageal cancer: Commonly familial, possibly heritable.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.23 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 23-23

Author(s):

Niamh Peters ◽

Sinead King ◽

Emily O'Donovan ◽

David James Gallagher ◽

John V Reynolds

Keyword(s):

Family History ◽

Oesophageal Cancer ◽

Cancer Genetics ◽

Age At Diagnosis ◽

Degree Relative ◽

Genetic Database ◽

The Family ◽

History Of ◽

Oesophageal Surgery ◽

Genetic Assessment

23 Background: Oesophageal cancer (OC) accounts for 400 deaths in Ireland per year. Prognosis remains poor, and improved prevention is needed. Familial clustering has been described however, The Nordic Twin Study of Cancer does not support a strong hereditability. We investigated familial OC over a decade in Ireland. Methods: The independent records of two national referral services were reviewed: an oesophageal surgery database and a hereditary cancer genetics database. Demographic Factors including family history of OC were recorded from the surgical database. Families containing a single OC diagnosis were identified in the genetics database. Age at diagnosis and additional cancer diagnoses in the family were recorded. Results: 1238 patients with OC were seen at St. James’s Hospital from 2005 to 2015. Demographic characteristics are shown in Table. 641 patients (51%) had a family history of malignancy. Seventy eight (6.3%) reported a family history of OC, 6 (7.6%) of whom had two or more first degree relatives with OC and 10 (13%) had both a first degree and second degree relative with OC. More male relatives were diagnosed with OC than female (59% vs 41%).The majority (24%) with a family history were diagnosed at Stage III, the majority (29%) without a family history were diagnosed at Stage II. 1840 pedigrees from the genetic database were reviewed. No pedigree contained a Proband with OC.4.5%(n = 84) included at least one family member with OC. The median age at diagnosis was 64. Breast, colorectal and gastric were the most commonly associated cancers with median ages of 50,59 and 64 respectively. Conclusions: More than half of patients presenting with OC report a family history of cancer, with likely hereditary and environmental components. OC patients are rarely referred for genetic assessment, possibly due to treatment related morbidity and poor clinical outcome. [Table: see text]

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TYPE II DIABETICS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.02.860 ◽

2016 ◽

Vol 23 (02) ◽

pp. 133-137

Author(s):

Azfar Farogh ◽

Muhammad Arif Mahmood ◽

Khalil Ahmad

Keyword(s):

Diabetes Mellitus ◽

Family History ◽

Diabetic Ketoacidosis ◽

Type Ii Diabetes Mellitus ◽

Cross Sectional Study ◽

Type Ii ◽

Cross Sectional ◽

Family History Of Diabetes ◽

Study Results ◽

History Of

Objectives: To determine the frequency of diabetic ketoacidosis in type IIdiabetic patients. Study Design: Cross sectional study. Setting: Department of Medicine,Sahiwal Medical College Sahiwal. Period: September 2014 to March 2015. Material andmethod: Permission was taken from Institutional review board and written informed consentwas taken from every patient. Total 189 patients with type II DM (Un-controlled) having Fastingplasma glucose level ≥126mg/dl either male or female having age 35 years to 65 years wereincluded in the study. Results: Total 189 patients with type II diabetes mellitus were includedin this study. Mean age of the 50.09 ± 9.39 years. Male patients were 79 (42%) and femalepatients were 110 (58%). Insignificant association between gander and Ketoacidosis was seen.No association of family history of diabetes mellitus with Ketoacidosis was found. Conclusion:Results of this study showed that male or female can be equally victim of diabetic ketoacidosis.Diabetic ketoacidosis can be develop equally in younger or older age group. No significantdifference for the development of diabetic ketoacidosis was found between obese/non-obeseand patients with family history of diabetes or without family history of diabetes.

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