scholarly journals 10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

2021 ◽  
Vol 12 ◽  
Author(s):  
Wei Peng ◽  
Jinna Yuan ◽  
Valentina Chiavaroli ◽  
Guanping Dong ◽  
Ke Huang ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Abdominal Pain ◽  
Diabetic Ketoacidosis ◽  
Primary Care Physicians ◽  
Clinical Symptoms ◽  
Diabetes Diagnosis ◽  
Regional Center ◽  
Retrospective Audit ◽  
Number Of Patients

BackgroundDiabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes (T1D), and a leading cause of death in children aged <15 years with new-onset T1D.Aimsi) to assess the incidence of DKA in children and adolescents newly diagnosed with T1D over a 10-year period at a large regional center in China; and ii) to examine the clinical symptoms and demographic factors associated with DKA and its severity at diagnosis.MethodsWe carried out a retrospective audit of a regional center, encompassing all youth aged <16 years diagnosed with T1D in 2009–2018 at the Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China). DKA and its severity were classified according to ISPAD 2018 guidelines.Results681 children were diagnosed with T1D, 50.1% having DKA at presentation (36.0% mild, 30.0% moderate, and 33.9% severe DKA). The number of patients diagnosed with T1D progressively rose from approximately 39 cases/year in 2009–2010 to 95 cases/year in 2017–2018 (≈2.5-fold increase), rising primarily among children aged 5–9 years. DKA incidence was unchanged but variable (44.8% to 56.8%). At T1D diagnosis, 89% of patients reported polyuria and 91% polydipsia. Children presenting with DKA were more likely to report vomiting, abdominal pain, and particularly fatigue. DKA was most common among the youngest children, affecting 4 in 5 children aged <2 years (81.4%), in comparison to 53.3%, 42.7%, and 49.3% of patients aged 2–4, 5–9, and ≥10 years, respectively. Children with severe DKA were more likely to report vomiting, fatigue, and abdominal pain, but less likely to report polyuria, polydipsia, and polyphagia than those with mild/moderate DKA. Rates of severe DKA were highest in children aged <2 years (51.1%).ConclusionsThe number of children diagnosed with T1D at our regional center increased over the study period, but DKA rates were unchanged. With 9 of 10 children reporting polyuria and polydipsia prior to T1D diagnosis, increasing awareness of this condition in the community and among primary care physicians could lead to earlier diagnosis, and thus potentially reduce rates of DKA at presentation.

scholarly journals MON-107 Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children from a Large Centre (Hangzhou, China)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Wei Peng ◽  
Binghan Jin ◽  
Jinna Yuan ◽  
Guanping Dong ◽  
Hu Lin ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Biochemical Parameters ◽  
Clinical Symptoms ◽  
Blood Gases ◽  
Diabetes Diagnosis ◽  
School Of Medicine ◽  
High Incidence ◽  
Loss Of Appetite

Abstract Objective: To review the clinical symptoms and biochemical parameters associated with diabetic ketoacidosis (DKA) in children newly diagnosed with type 1 diabetes (T1D) in our single medical centre over 10 years. Methods: Participants were children aged <16 years diagnosed with T1D between 1 January 2009 and 31 December 2018 at the Children’s Hospital, at Zhejiang University School of Medicine (Hangzhou, China). DKA occurrence was assessed by blood gases using pH and bicarbonate. The severity of DKA was categorized according to ISPAD 2014 guidelines, as mild, moderate, or severe. The child’s history prior to diagnosis was recorded, and patients underwent a number of clinical assessments, including anthropometry, biochemical parameters, and OGTT. The demographic and clinical characteristics of children with and without DKA were compared. Results: 681 patients (314 boys and 367 girls) were diagnosed with T1D over the study period. 341 (50.1%) had DKA at diagnosis, with yearly rates ranging from 45.0% to 56.8%. Eight cases had missing data on severity, but 120 had mild (36.0%), 100 moderate (30.0%), and 113 severe (33.9%) DKA. Children with DKA were younger than those without DKA (7.2 vs 8.2 years, respectively; p=0.001), and were more likely to report vomiting (13.2% vs 1.5%; p<0.001), loss of appetite (3.2% vs 0.9%; p=0.031), fatigue (39.3% vs 5.6%; p<0.001), and abdominal pain (9.1% vs 1.5%; p<0.001) prior to T1D diagnosis. The classical symptoms of diabetes were similar in children with and without DKA, such as polyuria (86.8% vs 90.3%, respectively; p=0.153), polydipsia (90.6% vs 91.5%; p=0.696), polyphagia (26.4% vs 30.3%; p=0.259), and weight loss (50.7% vs 50.6%; p=0.970). Children with DKA had higher blood lipids and fasting insulin levels at presentation, but displayed similar HbA1c levels. Conclusions: We report a high incidence of DKA at our centre (50%) among children diagnosed with T1D. As most children displayed classical symptoms of diabetes, it is important to increase community awareness of the disease to ensure an early diagnosis and lower the risk of children presenting with DKA.

scholarly journals Cognitive Function following Diabetic Ketoacidosis in Children with New Onset or Previously Diagnosed Type 1 Diabetes

2020 ◽  
Author(s):  
Simona Ghetti ◽  
Nathan Kuppermann ◽  
Arleta Rewers ◽  
Sage R. Myers ◽  
Jeff E. Schunk ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hemoglobin A1c ◽  
Economic Status ◽  
Digit Span ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Neurocognitive Assessment ◽  
New Onset

<b>Objective. </b>This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes, and whether the same is true in children who had been previously diagnosed after accounting for variations in glycemic control and other relevant factors.<b> Design. </b>We prospectively enrolled 758 children, 6- to 18-years-old, who presented with DKA in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled. <b>Results. </b>Among all patients, moderate/severe DKA was associated with lower IQ (β=-.12, p<0.001), item-color recall (β=-0.08, p=0.010), and forward digit span (β=-0.06, p=0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β=-0.08, p=0.04). Among previously diagnosed patients, repeated DKA exposure and higher hemoglobin A1c were independently associated with lower IQ (β=-.10 and β=-0.09, respectively, ps <.01) and higher hemoglobin A1c was associated with lower item-color recall (β=-0.10, p=0.007), after accounting for hypoglycemia, diabetes duration, and socio-economic status.<b> Conclusion. </b>A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.<b> <br> </b>

scholarly journals A szöveti antitranszglutamináz átmeneti emelkedése coeliakiával nem társult I-es típusú cukorbeteg gyermekekben

2021 ◽  
Vol 162 (48) ◽  
pp. 1924-1930
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Coeliac Disease ◽  
Clinical Symptoms ◽  
Tissue Transglutaminase ◽  
Diabetes Diagnosis ◽  
Igg Antibody ◽  
Tissue Transglutaminase Antibodies ◽  
Antibody Levels

Összefoglaló. Bevezetés: Az 1-es típusú diabetes mellitus és a coeliakia gyakori társulása jól ismert. Néhány tanulmány beszámol átmeneti antitranszglutamináz-emelkedésről 1-es típusú diabeteses betegekben, akiknél az emelkedett antitestszint gluténmentes diéta bevezetése nélkül normalizálódik. Célkitűzés: Kutatásunk során az átmeneti antitranszglutamináz-emelkedés gyakoriságának meghatározását tűztük ki célul. További célunk volt a coeliakia gyakoriságának megállapítása 1-es típusú diabetesszel gondozott betegeink között. Módszer: A Semmelweis Egyetem I. Gyermekgyógyászati Klinikáján 1-es típusú diabetesszel gondozott betegeket vontuk be vizsgálatunkba (238 lány, 265 fiú, medián [IR] életkor az 1-es típusú diabetes diagnózisakor: 7,83 [4,67–11] év). Vizsgáltuk a jelenség időbeli megjelenését, az emelkedés mértékét, gyakoriságát és az antitest típusát. Leíró statisztikai módszereket és khi-négyzet-próbát alkalmaztunk. Eredmények: A vizsgált populációban a coeliakia gyakorisága 12,52%. Átmeneti antitranszglutamináztiter-emelkedést 48 gyermeknél (10,9%) észleltünk. Összesen 71-szer mértünk átmeneti antitranszglutamináz-emelkedést. A gyermekek közül 34 esetben (70,83%) egyszer fordult elő emelkedést mutató antitest, a többi betegnél 2–8 alkalommal. Gyakrabban tapasztaltunk izolált IgA-típusú emelkedést, mint izolált IgG-típusút (54 vs. 5). Következtetés: Az átmeneti antitranszglutamináz-emelkedés gyakorisága magas, összevethető a valódi coeliakiás csoporttal. Kutatásunk alátámasztja a nemzetközi ajánlást, miszerint mérsékelt mértékű antitranszglutamináz-emelkedés esetén, tünetmentes 1-es típusú diabetesszel gondozott betegben a gluténfogyasztás folytatása és az antitestszintek gyakori kontrollja javasolt. Orv Hetil. 2021; 162(48): 1924–1930. Summary. Introduction: The frequent association of type 1 diabetes mellitus with coeliac disease is well known. Development of transitional elevation of anti-tissue transglutaminase antibodies in the diagnosis of type 1 diabetes is reported in some studies. In these cases, the anti-tissue transglutaminase antibodies returned to normal without gluten-free diet. Objective: Our aim was to assess the frequency of transitional elevation of anti-tissue transglutaminase in our type 1 diabetes patients. We aimed to investigate the prevalence of coeliac disease in patients with type 1 diabetes. Method: Patients with type 1 diabetes at the Ist Department of Paediatrics, Semmelweis University, were enrolled in the study (238 girls, 265 boys; the median age at the time of type 1 diabetes diagnosis was 7.83 [4.67–11] years). Descriptive statistical analysis was done and the time of appearance, extent, frequency and type of elevated anti-tissue transglutaminase antibodies were examined. Results: The proportion of children with diagnosed coeliac disease was 12.52%. We detected transitional anti-tissue transglutaminase elevation in 48 cases (10.9%). Temporarily elevated antibody levels were measured 71 times. In 34 children (70.83%), the temporary elevation occured once, while in the others, antibody levels became positive 2–8 times. The elevation of the IgA antibody was more frequent than the elevation of the IgG antibody (54 vs. 5). Conclusion: The frequency of temporary elevated anti-tissue transglutaminase levels is considered high. Our study confirms the recommendation that in the case of moderate anti-tissue transglutaminase levels with lack of clinical symptoms, control antibody measurement is necessary with ongoing gluten consumption. Orv Hetil. 2021; 162(48): 1924–1930.

scholarly journals Clinical features and risk factors for diabetic ketoacidosis in type 1 diabetes mellitus at tertiary care centre, Maharashtra, India

2020 ◽  
Vol 7 (5) ◽  
pp. 745
Author(s):  
Vijaykumar Gaikwad ◽  
J. K. Deshmukh ◽  
Prachi Deshmukh ◽  
Anant A. Takalkar
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Risk Factor ◽  
Abdominal Pain ◽  
Diabetic Ketoacidosis ◽  
Clinical Features ◽  
Common Risk Factor ◽  
Essential Components ◽  
Tract Infections

Background: Diabetes Mellitus is increasing in incidence, prevalence and importance as a chronic disease throughout the world. The International Diabetes Federation projects that by 2030 there will be 438 million people with diabetes on a global scale. Three essential components of Diabetic Ketoacidosis are hyperglycemia, ketosis, and resultant metabolic acidosis.  4% of all patients with diabetes and 20% of those with Type 1 Diabetes are admitted to hospital with manifestations of ketoacidosis. Objectives was to study clinical profile of patients presenting as Diabetic Ketoacidosis.Methods: It is a descriptive observational study was conducted at Department of Medicine, Dr. Shankarrao Chavan Medical College and Hospital, Nanded. The study included 77 patients of diabetic ketoacidosis (DKA) from Male Medicine ward, Female Medicine ward, Medical Intensive Care Unit. The study was carried out during Jan 2012 to October 2013. The data was analyzed using SPSS 24.0 version.Results: Majority of the subjects were from 10-20 years age group i.e. 31(40.3%). 51.9% were males and 42.9% were females. 38(49.4%) have onset of Diabetes type 1 between 10- 20 years of age and mean±S.D.20.11±7.09yrs. Most common symptoms at the time of admission were abdominal pain in 54(70.1%), vomiting in 52(67.5%), nausea in 41(53.2%) and fatigue in 40(51.9%) patients. Most common risk factor for DKA was found to be infections in 36(46.8%) patients.Conclusions: Most common clinical features of Diabetic Ketoacidosis were abdominal pain, vomiting, nausea and fatigue. Most common risk factor for Diabetic Ketoacidosis was infection followed by omission of treatment or irregular treatment. The most common infections were due to urinary tract & respiratory tract infections.

scholarly journals Cognitive Function following Diabetic Ketoacidosis in Children with New Onset or Previously Diagnosed Type 1 Diabetes

2020 ◽  
Author(s):  
Simona Ghetti ◽  
Nathan Kuppermann ◽  
Arleta Rewers ◽  
Sage R. Myers ◽  
Jeff E. Schunk ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hemoglobin A1c ◽  
Economic Status ◽  
Digit Span ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Neurocognitive Assessment ◽  
New Onset

<b>Objective. </b>This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes, and whether the same is true in children who had been previously diagnosed after accounting for variations in glycemic control and other relevant factors.<b> Design. </b>We prospectively enrolled 758 children, 6- to 18-years-old, who presented with DKA in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled. <b>Results. </b>Among all patients, moderate/severe DKA was associated with lower IQ (β=-.12, p<0.001), item-color recall (β=-0.08, p=0.010), and forward digit span (β=-0.06, p=0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β=-0.08, p=0.04). Among previously diagnosed patients, repeated DKA exposure and higher hemoglobin A1c were independently associated with lower IQ (β=-.10 and β=-0.09, respectively, ps <.01) and higher hemoglobin A1c was associated with lower item-color recall (β=-0.10, p=0.007), after accounting for hypoglycemia, diabetes duration, and socio-economic status.<b> Conclusion. </b>A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.<b> <br> </b>

Overweight Individuals with Type 1 Diabetes Are Less Likely to Present with Diabetic Ketoacidosis—Data from the After Diabetes Diagnosis Research Support System (ADDRESS-2) Cohort

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1696-P
Author(s):  
SHIVANI MISRA ◽  
AKAAL KAUR ◽  
IAN F. GODSLAND ◽  
HELEN C. WALKEY ◽  
DESMOND G. JOHNSTON ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Support System ◽  
Diabetes Diagnosis ◽  
Research Support ◽  
Research Support System

scholarly journals Empagliflozin-induced Diabetic Ketoacidosis Unmasking a Type 1 Diabetes Diagnosis

2019 ◽  
Vol 3 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Gretchen Ray ◽  
Chelsea Rodriguez ◽  
Samantha Schulman ◽  
Preeyaporn Sarangarm ◽  
Michelle Bardack ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Diabetes Diagnosis

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

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.

scholarly journals Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children during the COVID ‐19 Pandemic

2021 ◽  
Author(s):  
Josephine Ho ◽  
Elizabeth Rosolowsky ◽  
Daniele Pacaud ◽  
Carol Huang ◽  
Julie‐Anne Lemay ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Diabetes Diagnosis

Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis

2020 ◽  
Vol 13 (12) ◽  
pp. e237229
Author(s):  
Nikhil Shah ◽  
Vaman Khadilkar ◽  
Anuradha Khadilkar ◽  
Rahul Jahagirdar
Keyword(s):  
Type 1 Diabetes ◽  
Abdominal Pain ◽  
Diabetic Ketoacidosis ◽  
Clinical Presentation ◽  
Gastrointestinal Symptoms ◽  
Exploratory Laparotomy ◽  
Lead Point ◽  
Meckel Diverticulum ◽  
Viral Aetiology

Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of acidosis, the gastrointestinal symptoms persisted for which an ultrasonography of the abdomen was performed. It revealed an ileo-ileal intussusception, which was confirmed by a CT scan. He underwent an exploratory laparotomy. After reduction of the intussusception, a Meckel diverticulum was found as the lead point that was then resected. We present a case of a child with type 1 diabetes having an intussusception due to Meckel diverticulum, which was probably made worse by the decreased intestinal motility due to hyperglycaemia. Intussusception should thus be suspected in patients with diabetic ketoacidosis if the pain is persistent despite correction of acidosis.

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