PRECIPITATING FACTORS, CLINICAL PROFILE AND METABOLIC ABNORMALITIES OF DIABETIC KETOACIDOSIS IN CHILDREN WITH TYPE 1 DIABETES AND THEIR ROLE IN PREDICTING THE OUTCOME

Background: Type-1 Diabetes Mellitus is the most common endocrine-metabolic disorder of childhood and adolescence. The diseases has a prevalence of approximately 1 in 2500 children at age 5 years to approximately 1 in 300 children by age 18 years. A recent study from Madras suggests that diabetes in Indian children is present in a frequency of 10.5 per 1,00,000 patient years. Prevalence of childhood diabetes among urban population in India is 0.26 per 1000. Type-1 diabetes constituted nearly 90 to 100% of all children with diabetes. Objective: The objectives of this research were to study the levels of glycosylated hemoglobin and lipid profile in type 1 diabetes mellitus in children attending Gandhi Hospital Secunderabad, Telangana and to study the precipitating factors in Diabetic Ketoacidosis (DKA). Subjects and Methods:Design: This was a Cross-Sectional study. Duration: One year and six months i.e. from January 2017 to June 2018. Participants: 50 diabetic children of age less than 18 years attending Gandhi Hospital, Secunderabad, Telangana were included in the study.The diabetic cases were studied using a predesigned and pretested proforma. A detailed clinical examination was carried out with detailed anthropometric measurements and necessary lab investigations were done. Metabolic profile was assessed by investigating for blood sugar levels, glycosylated hemoglobin, and lipid profile. Rates, ratios and percentages of presentations and significance were calculated using Chi-square test.Result:48 % cases had onset of diabetes Mellitus at 13-18 years with Male: female ratio of 1.27: 1. 20 % had family history of diabetes. 16 % children had normal nutrition, 20 % children had grade I and grade II, 38% had grade III and 6 % children had grade IV. 54% children had glycosylated hemoglobin level of more than 10% indicating poor glycemic control, 32 % had fair control, and 14 % had good glycosylated hemoglobin levels. 62 % presented with fever , 40 % presented with symptoms of polyuria, polydipsia and polyphagia, 37.5 % presented with vomiting, 18 % children with loose stools, abdominal pain, 20 % children had breathlessness, 6% presented with seizures. 88.9% were diagnosed to have diabetic ketoacidosis as their initial presentation of diabetes mellitus Causes for precipitating factors of diabetic ketoacidosis were associated infections like pneumonia (22 %) and urinary tract infection(16 %), Non availability of insulin doses (25%), non-acceptance by child (16.66 %). Recurrent hospitalization in the patients with 5 years diabetic duration was statistically significant. Common causes being hypoglycemia (38 %) recurrent DKA (24 %), pneumonia (12 %) and urinary tract infections (8 %). 23.52% cases were non-compliant.Conclusion:More than half of the cases(54%) had poor glycemic control. Majority presented with classical symptoms of polyuria, polydipsia, polyphagia, fever, breathlessness and diabetic ketoacidosis as clinical presentation. Causes for precipitating factors of diabetic ketoacidosis were associated infections like pneumonia and urinary tract infection, non-availability of insulin doses and non- acceptance by child.

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Precipitating Factors for Diabetic Ketoacidosis among Patients with Type 1 Diabetes Mellitus: The Effect of Socioeconomic Status

International Journal of Diabetes and Metabolism ◽

10.1159/000499839 ◽

2019 ◽

Vol 25 (1-2) ◽

pp. 52-60

Author(s):

Ahmed Hakim Al-Obaidi ◽

Haider Ayad Alidrisi ◽

Abbas Ali Mansour

Keyword(s):

Diabetes Mellitus ◽

Socioeconomic Status ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Precipitating Factors

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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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Frequency, precipitating factors and outcome of diabetic ketoacidosis in type 1 diabetes at tertiary care hospital

10.26226/morressier.59d51848d462b80296ca2f75 ◽

2017 ◽

Author(s):

Khan Muhammad Imran Hasan

Keyword(s):

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Precipitating Factors

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Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations on the use of sodium-glucose co-transporter inhibitors with insulin for treatment of type 1 diabetes (updated October 2020)

British Journal of Diabetes ◽

10.15277/bjd.2020.265 ◽

2020 ◽

Vol 20 (2) ◽

pp. 155-162

Author(s):

Umesh Dashora ◽

Dipesh C Patel ◽

Robert Gregory ◽

Peter Winocour ◽

Ketan Dhatariya ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Position Statement ◽

Precipitating Factors ◽

Excessive Alcohol Consumption ◽

Excessive Exercise ◽

Added Benefit ◽

Excessive Alcohol ◽

The Uk

Dapagliflozin (sodium-glucose co-transporter (SGLT-2) inhibitor) and sotagliflozin (SGLT-1/2 inhibitor) are two of the drugs of the SGLT inhibitor class which have been recommended by the National Institute for Health and Care Excellence (NICE) in people with type 1 diabetes with body mass index ≥27 kg/m2. Dapagliflozin is licensed in the UK for use in the NHS while sotagliflozin may be available in future. These and possibly other SGLT inhibitors may be increasingly used in people with type 1 diabetes as new licences are obtained. These drugs have the potential to improve glycaemic control in people with type 1 diabetes with the added benefit of weight loss, better control of blood pressure and more time in optimal glucose range. However, SGLT inhibitors are associated with a higher incidence of diabetic ketoacidosis without significant hyperglycaemia. The present ABCD/Diabetes UK joint updated position statement is to guide people with type 1 diabetes and clinicians using these drugs to help mitigate this risk and other potential complications. Particularly, caution needs to be exercised in people who are at risk of diabetic ketoacidosis due to low calorie diets, illnesses, injuries, starvation, excessive exercise, excessive alcohol consumption and reduced insulin administration, among other precipitating factors for diabetic ketoacidosis.

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