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Khater S, Aouar A, Bensmain N, Bendedouche S, Chabni N, Hamdaoui H, Moussouni A, Moqaddem Z. Very High Incidence of Type 1 Diabetes Among Children Aged Under 15 Years in Tlemcen, Northwest Algeria (2015-2018). J Clin Res Pediatr Endocrinol 2021; 13:44-51. [PMID: 32938578 PMCID: PMC7947720 DOI: 10.4274/jcrpe.galenos.2020.2020.0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/07/2020] [Indexed: 02/02/2023] Open
Abstract
Objective In Algeria, there is a lack of epidemiological data concerning childhood type 1 diabetes (T1D). The International Diabetes Federation estimated in 2019 that Algeria ranked 7th among countries with the highest prevalence of T1D. This study aimed to determine the incidence of T1D in children <15 years, living in Tlemcen in Northwest Algeria. Methods A retrospective study using data from children (<15 years) who have been diagnosed with T1D in Tlemcen between 2015 and 2018, using the two-source capture–recapture method to estimate the completeness of ascertainment (%). Total average incidences, by sex, by onset age group, and by season of onset were calculated per 100,000 and per year. Results During the study period, 437 new cases of T1D were registered, among them, 233 boys and 204 girls, with a sex ratio of 1.14. The average annual incidence rate of childhood T1D was 38.5/100,000 with a 95% confidence interval (CI): 35.20-41.79; boys: 40.51, 95% CI: 38.16-42.85; girls: 36.49, 95% CI: 34.17-38.80. Overall incidence rates in 2015, 2016, 2017 and 2018 were respectively 36.6 (95% CI: 33.72-39.48), 38.7 (95% CI: 35.43-41.97), 39.3 (95% CI: 35.97-42.62) and 39.5 (95% CI: 36.12-42.87)/100,000. Newly diagnosed children were more likely to present in winter and autumn. Ketoacidosis at diagnosis was diagnosed in 29.2%. Conclusion The mean incidence of childhood T1D in Tlemcen was 38.5/100,000, this incidence is in the “extremely high” category of the World Health Organization DiaMond project classification of diabetes giving this region a very high risk.
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Affiliation(s)
- Sarra Khater
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | - Ammaria Aouar
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | - Nawel Bensmain
- Abou Beker Belkaid University, Statistics and Random Models Laboratory, Tlemcen, Algeria
| | - Salih Bendedouche
- Abou Beker Belkaid University, Tlemcen University Hospital, Department of Pediatrics, Tlemcen, Algeria
| | - Nafissa Chabni
- Abou Beker Belkaid University, Tlemcen University Hospital, Department of Epidemiology, Tlemcen, Algeria
| | - Houari Hamdaoui
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
| | | | - Zakarya Moqaddem
- Abou Beker Belkaid University, Valorisation of Human Actions for the Protection of the Environment and Application in Public Health Laboratory, Tlemcen, Algeria
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Praveen PA, Hockett CW, Ong TC, Anandakumar A, Isom SP, Jensen ET, Mohan V, Dabelea DA, D'Agostino RB, Hamman RF, Mayer-Davis EJ, Lawrence JM, Dolan LM, Kahn MG, Madhu SV, Tandon N. Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: Results from SEARCH (United States) and YDR (India) registries. Pediatr Diabetes 2021; 22:40-46. [PMID: 31943641 PMCID: PMC7748377 DOI: 10.1111/pedi.12979] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/12/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries. METHODS We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH. RESULTS There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4). CONCLUSIONS There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.
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Affiliation(s)
- Pradeep A Praveen
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Christine W Hockett
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Toan C Ong
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Amutha Anandakumar
- Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Scott P Isom
- Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elizabeth T Jensen
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Dana A Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Ralph B D'Agostino
- Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Richard F Hamman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | | | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lawrence M. Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael G Kahn
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - SV Madhu
- University College of Medical Science, GTB Hospital, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Mavinkurve M, Jalaludin MY, Chan EWL, Noordin M, Samingan N, Leong A, Zaini AA. Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon? Front Endocrinol (Lausanne) 2021; 12:606018. [PMID: 33763028 PMCID: PMC7982891 DOI: 10.3389/fendo.2021.606018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Children with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts. AIM To report the rate of misdiagnosis and its associated risk factors in Malaysian children and adolescents with T1DM. METHODS A retrospective analysis of children with T1DM below 18 years of age over a 10 year period was conducted. RESULTS The cohort included 119 children (53.8% female) with a mean age 8.1 SD ± 3.9 years. 38.7% of cases were misdiagnosed, of which respiratory illnesses were the most common (37.0%) misdiagnosis. The rate of misdiagnosis remained the same over the 10 year period. Among the variables examined, younger age at presentation, DKA at presentation, healthcare professional (HCP) contact and admission to the intensive care unit were significantly different between the misdiagnosed and correctly diagnosed groups (p <0.05). CONCLUSION Misdiagnosis of T1DM occurs more frequently in Malaysian children <5 years of age. Misdiagnosed cases are at a higher risk of presenting in DKA with increased risk of ICU admission and more likely to have had prior HCP contact. Awareness of T1DM amongst healthcare professionals is crucial for early identification, prevention of DKA and reducing rates of misdiagnosis.
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Affiliation(s)
- Meenal Mavinkurve
- Department of Paediatrics, School of Medicine, International Medical University, Wilayah Persekutuan, Kuala Lumpur, Malaysia
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Yazid Jalaludin
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Elaine Wan Ling Chan
- Institute for Research, Development and Innovation, International Medical University, Kuala Lumpur, Malaysia
| | - Mazidah Noordin
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, School of Medicine, University Teknologi MARA, Selangor, Malaysia
| | - Nurshadia Samingan
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Annie Leong
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azriyanti Anuar Zaini
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Azriyanti Anuar Zaini,
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Kidie AA, Lakew AM, Ayele T. Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia. Diabetes Metab Syndr Obes 2021; 14:4819-4827. [PMID: 34984014 PMCID: PMC8699764 DOI: 10.2147/dmso.s326537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia. METHODS An institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia's information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance. RESULTS The average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05-2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17-14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02-4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22-2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94-0.97). CONCLUSION Having an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.
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Affiliation(s)
- Atitegeb Abera Kidie
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Correspondence: Ayenew Molla Lakew Email
| | - Tiruneh Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Peng W, Yuan J, Chiavaroli V, Dong G, Huang K, Wu W, Ullah R, Jin B, Lin H, Derraik JGB, Fu J. 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). Front Endocrinol (Lausanne) 2021; 12:653519. [PMID: 33986725 PMCID: PMC8112199 DOI: 10.3389/fendo.2021.653519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic 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. AIMS i) 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. METHODS We 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. RESULTS 681 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%). CONCLUSIONS The 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.
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Affiliation(s)
- Wei Peng
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinna Yuan
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Valentina Chiavaroli
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - Guanping Dong
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Rahim Ullah
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Binghan Jin
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hu Lin
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - José G. B. Derraik
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- NCD Centre of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Junfen Fu, ; ; José G. B. Derraik,
| | - Junfen Fu
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- *Correspondence: Junfen Fu, ; ; José G. B. Derraik,
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AlMutair A, AlSabty N, AlNuaim H, Al Hamdan R, Moukaddem A. Prevalence and special clinical and biochemical characteristics of familial type 1 (insulin dependent) diabetes mellitus in pediatric patients in a tertiary care setting. Int J Pediatr Adolesc Med 2020; 8:107-111. [PMID: 34084882 PMCID: PMC8144856 DOI: 10.1016/j.ijpam.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Background and Objectives The hereditable nature of type 1 diabetes mellitus (T1DM) makes it a condition that is in some cases shared among siblings. Studies that focus on the epidemiology of T1DM among siblings are scarce. The primary focus of the study is to estimate the prevalence of familial T1DM among siblings and the secondary focus is to identify the presence of any special clinical or biochemical characteristics specific to this entity. Methods In a retrospective cross-sectional study, the charts of 308 children (>1 year) diagnosed with type 1 diabetes mellitus in a Saudi tertiary care setting were reviewed. The patients who have one sibling or more with T1DM were included. The prevalence of familial T1DM among siblings was calculated, and specific clinical and biochemical characteristics were investigated. Data were analyzed using Statistical Package for the Social Sciences software version 22 (IBM SPSS Statistics for Windows). The control group includes all patients with type I DM who were excluded for sibling with DM. Results The prevalence of familial T1DM among siblings was estimated at 15.9%. Seventy-four percent of the patients with a positive family history of diabetes mellitus had one affected sibling only. The clinical presentation showed no significant differences relative to the age of presentation, gender, parental consanguinity, diabetic ketoacidosis at presentation, and its number of episodes. For the biochemical characteristics, autoantibody tests revealed no statistically significant difference, but the mean initial HbA1c levels were lower in patients who had diabetic siblings. Conclusion The prevalence of familial T1DM was found to be higher than that reported in other studies. No specific clinical or biochemical features were found to characterize familial T1DM among siblings.
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Affiliation(s)
- Angham AlMutair
- Pediatric Endocrine Division, Department of Pediatrics, King Abdullah Specialist Children Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs Riyadh, Saudi Arabia
| | - Norah AlSabty
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Hala AlNuaim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Rawan Al Hamdan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Afaf Moukaddem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
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Castellanos L, Tuffaha M, Koren D, Levitsky LL. Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus. Paediatr Drugs 2020; 22:357-367. [PMID: 32449138 DOI: 10.1007/s40272-020-00397-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of 'ketone bodies' into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.
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Affiliation(s)
- Luz Castellanos
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Marwa Tuffaha
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Dorit Koren
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA.
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Cherubini V, Grimsmann JM, Åkesson K, Birkebæk NH, Cinek O, Dovč K, Gesuita R, Gregory JW, Hanas R, Hofer SE, Holl RW, Jefferies C, Joner G, King BR, Mayer-Davis EJ, Peña AS, Rami-Merhar B, Schierloh U, Skrivarhaug T, Sumnik Z, Svensson J, Warner JT, Bratina N, Dabelea D. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia 2020; 63:1530-1541. [PMID: 32382815 PMCID: PMC7351855 DOI: 10.1007/s00125-020-05152-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. METHODS An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status. RESULTS During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5-11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia. CONCLUSIONS/INTERPRETATION DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.
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Affiliation(s)
- Valentino Cherubini
- Division of Pediatric Diabetology, Department of Women's and Children's Health, Salesi Hospital, Ancona, Italy
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081, Ulm, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Karin Åkesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Niels H Birkebæk
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czechia
| | - Klemen Dovč
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital and Faculty of Medicine, Ljubljana, Slovenia
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Via Tronto 10/a, 60020, Ancona, Italy.
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
- Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
| | - Sabine E Hofer
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Craig Jefferies
- Department of Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Geir Joner
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruce R King
- Department of Paediatric Diabetes, John Hunter Children's Hospital, Faculty of Medicine, University of Newcastle, Newcastle, NSW, Australia
| | | | - Alexia S Peña
- Paediatrics, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Schierloh
- DECCP, Clinique Pédiatrique, Centre Hospitalier, Luxembourg, Luxembourg
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czechia
| | - Jannet Svensson
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev, Denmark
| | - Justin T Warner
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - Nataša Bratina
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital and Faculty of Medicine, Ljubljana, Slovenia
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Pitocco D, Di Leo M, Tartaglione L, Rizzo EG, Caputo S, Rizzi A, Pontecorvi A. An Approach to Diabetic Ketoacidosis in an Emergency Setting. Rev Recent Clin Trials 2020; 15:278-288. [PMID: 32646361 DOI: 10.2174/1574887115666200709172402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon. METHODS Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter-regulatory hormones. RESULTS Goals of therapy are to correct dehydration, acidosis, and to reverse ketosis, gradually restoring blood glucose concentration to near normal. CONCLUSION It is essential to monitor potential complications of DKA and, if necessary, to treat them and any precipitating events.
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Affiliation(s)
- Dario Pitocco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Mauro Di Leo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Linda Tartaglione
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Emanuele Gaetano Rizzo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Salvatore Caputo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Alessandro Rizzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
| | - Alfredo Pontecorvi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, Roma, Italy
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60
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Ahmed AM, Khabour OF, Ahmed SM, Alebaid IA, Ibrahim AM. Frequency and severity of ketoacidosis at diagnosis among childhood type 1 diabetes in Khartoum state, Sudan. Afr Health Sci 2020; 20:841-848. [PMID: 33163051 PMCID: PMC7609092 DOI: 10.4314/ahs.v20i2.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a potentially life threatening acute complication of Type I diabetes mellitus (T1DM). This study aimed to determine the frequency and clinical characteristics of pediatric DKA at diagnosis of new-onset T1DM in Khartoum during 2000-2017 period. METHODS The study was retrospective and involved review of medical files of children (<15 years) with T1DM in the city hospitals and diabetes centers. RESULTS The overall frequency of DKA among T1DM children at onset of disease diagnosis was 17.6% (173/982). The episodes of DKA increased from 26% in first 6- year period (2000-2005) to 46.3% in the last 6-year period (2011-2012; p<0.001). No significant difference in the frequency of DKA was observed according to gender (p=0.9) and age (p=0.24). Compared to other age groups, the severity of DKA (pH<7.1) was higher in pre-school children (p<0.01). Approximately, 5% of patients were complicated with cerebral edema with a mortality rate of 1.7%. CONCLUSION The DKA frequency at diagnosis of childhood T1DM in Khartoum was lower than previous reports. In addition, the severity of DKA was high among pre-school age children with a relatively high mortality rate when compared to the global rate.
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Affiliation(s)
- Ahmed M Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Samia M Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia
| | | | - Amna M Ibrahim
- Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
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Abstract
Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.
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Affiliation(s)
- Ketan K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Nicole S Glaser
- Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, CA, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Piccini B, Schwandt A, Jefferies C, Kordonouri O, Limbert C, Arslanoglu I, Cardona-Hernandez R, Coutant R, Kim JH, Preiksa RT, Pundziute Lyckå A, Rami-Merhar B, Richmond E, Savova R, Todorovic S, Veeze HJ, Toni S. Association of diabetic ketoacidosis and HbA1c at onset with year-three HbA1c in children and adolescents with type 1 diabetes: Data from the International SWEET Registry. Pediatr Diabetes 2020; 21:339-348. [PMID: 31797499 DOI: 10.1111/pedi.12946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/25/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To establish whether diabetic ketoacidosis (DKA) or HbA1c at onset is associated with year-three HbA1c in children with type 1 diabetes (T1D). METHODS Children with T1D from the SWEET registry, diagnosed <18 years, with documented clinical presentation, HbA1c at onset and follow-up were included. Participants were categorized according to T1D onset: (a) DKA (DKA with coma, DKA without coma, no DKA); (b) HbA1c at onset (low [<10%], medium [10 to <12%], high [≥12%]). To adjust for demographics, linear regression was applied with interaction terms for DKA and HbA1c at onset groups (adjusted means with 95% CI). Association between year-three HbA1c and both HbA1c and presentation at onset was analyzed (Vuong test). RESULTS Among 1420 children (54% males; median age at onset 9.1 years [Q1;Q3: 5.8;12.2]), 6% of children experienced DKA with coma, 37% DKA without coma, and 57% no DKA. Year-three HbA1c was lower in the low compared to high HbA1c at onset group, both in the DKA without coma (7.1% [6.8;7.4] vs 7.6% [7.5;7.8], P = .03) and in the no DKA group (7.4% [7.2;7.5] vs 7.8% [7.6;7.9], P = .01), without differences between low and medium HbA1c at onset groups. Year-three HbA1c did not differ among HbA1c at onset groups in the DKA with coma group. HbA1c at onset as an explanatory variable was more closely associated with year-three HbA1c compared to presentation at onset groups (P = .02). CONCLUSIONS Year-three HbA1c is more closely related to HbA1c than to DKA at onset; earlier hyperglycemia detection might be crucial to improving year-three HbA1c.
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Affiliation(s)
- Barbara Piccini
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - Olga Kordonouri
- AUF DER BULT Children's Hospital, Diabetes Center for Children and Adolescents, Hannover, Germany
| | | | - Ilknur Arslanoglu
- Duzce University Faculty of Medicine, Pediatric Endocrinology, Duzce, Turkey
| | | | - Regis Coutant
- University Hospital Angers, Pediatric Endocrinology and Diabetology, Angers, France
| | - Jae Hyun Kim
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Auste Pundziute Lyckå
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgit Rami-Merhar
- Medical University of Vienna, Department of Pediatric and Adolescent Medicine, Vienna, Austria
| | | | | | - Sladjana Todorovic
- Institute for Mother and Child Healthcare of Serbia Dr. Vukan Cupic, Belgrade, Serbia
| | - Henk J Veeze
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Sonia Toni
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
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Lee S, Tsai M, Chang S, Chen J, Wang R. Modelling individual, parental and peer factors to glycaemic control in adolescents with type 1 diabetes: A prospective study. J Adv Nurs 2020; 76:1162-1171. [DOI: 10.1111/jan.14317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Shu‐Li Lee
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
| | - Meng‐Che Tsai
- Division of Genetics Metabolism and Endocrinology Department of Pediatrics National Cheng Kung University Hospital Tainan Taiwan
- Clinical Assistant Professor College of Medicine National Cheng Kung University Tainan Taiwan
| | - Shu‐Chen Chang
- Department of Nursing Changhua Christian Hospital Changhua Taiwan
- College of Nursing and Health Sciences Dayeh University Changhua Taiwan
| | - Jyu‐Lin Chen
- School of Nursing University of California San Francisco CA USA
| | - Ruey‐Hsia Wang
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
- Department of Medical Research Kaohsiung Medical University Chung‐Ho Memorial Hospital Kaohsiung Taiwan
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Madkhly TM, Mohammed FA, Majrashi HH, Kamili FH, Tawhari RAM, Hudisy AA, AbuDyab OAM, Mohajab AHA, Tumayhi GM. Final-year medical students' awareness and knowledge about DKA: A cross-sectional study from a Saudi University. J Family Med Prim Care 2020; 9:1076-1079. [PMID: 32318470 PMCID: PMC7114018 DOI: 10.4103/jfmpc.jfmpc_905_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Final-year medical students are soon to be physicians who are expected to have sufficient knowledge about a life-threatening condition such as diabetic ketoacidosis (DKA); thus, the present study aimed to evaluate awareness and knowledge of medical students about DKA in a large Saudi University. Methods: An online survey was conducted using a convenience sample of 81 participants aged 18 years and above from Jazan region, Saudi Arabia. Awareness and knowledge about DKA were assessed using a prestructured questionnaire. Statistical analysis using the Statistical Package of Social Sciences (SPSS) included descriptive studies and Chi-square or Fisher's exact test, with the significance level set at P value < 0.05. Results: A total of 81 valid responses were analyzed (85.3% response rate), of which 51.9% were males. The mean age was 23.06 (Standard deviation 1.66 years). Regarding basic information about diabetes mellitus, most of the respondents correctly answered questions related to the system involved in diabetes, classic symptoms, glycemic control test, and the meaning of postprandial blood sugar. Also, students had a good knowledge regarding DKA definition and management. However, inadequate knowledge was found regarding electrolyte disturbance in DKA (59% of males vs. 30.8% of females P = 0.014) and fluid replacement in DKA patients (P < 0.05). Conclusion: The present study revealed that students had a good knowledge regarding basic information about diabetes and DKA definition and management. Students’ knowledge was deficient regarding electrolyte disturbance and fluid replacement in DKA. Interventions using study seminars and workshops are warranted to increase knowledge about DKA among final-year medical students.
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Affiliation(s)
| | | | | | | | | | - Arwa A Hudisy
- Medical Intern, Jazan University, Jazan, Saudi Arabia
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Alonso GT, Coakley A, Pyle L, Manseau K, Thomas S, Rewers A. Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Colorado Children, 2010-2017. Diabetes Care 2020; 43:117-121. [PMID: 31601639 PMCID: PMC6925579 DOI: 10.2337/dc19-0428] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined trends in diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes at a large pediatric diabetes center between 2010 and 2017, overlapping with the Affordable Care Act's overhaul of U.S. health care. RESEARCH DESIGN AND METHODS Colorado residents <18 years old who were diagnosed with type 1 diabetes from 2010 to 2017 and subsequently followed at the Barbara Davis Center for Diabetes were included. Logistic regression models were used to test associations among age, sex, race/ethnicity, insurance, language, year of diagnosis, and rural/nonrural residence and DKA at diagnosis. Linear regression models were used to test the association of each predictor with HbA1c at diagnosis. RESULTS There were 2,429 subjects who met the inclusion criteria. From 2010 to 2017, the rate of DKA increased from 41 to 58%. It increased from 35.3 to 59.6% among patients with private insurance (odds ratio 1.10 [95% CI 1.05-1.15]; P < 0.0001) but remained unchanged (52.2-58.8%) among children with public insurance (1.03 [0.97-1.09]; P = 0.36). In the multivariable model, public insurance (1.33 [1.08-1.64]; P = 0.007), rural address (1.42 [1.08-1.86]; P = 0.013), and HbA1c (1.32 [1.26-1.38]; P < 0.0001) were positively associated with DKA, whereas age, race/ethnicity, sex, and primary language were not. CONCLUSIONS The increase in the rate of DKA in patients with newly diagnosed type 1 diabetes was driven by patients with private insurance. This paradoxically occurred during a time of increasing health insurance coverage. More study is needed to understand the factors driving these changes.
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Affiliation(s)
- G Todd Alonso
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alex Coakley
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | | | - Sarah Thomas
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Arleta Rewers
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Zabeen B, Govender D, Hassan Z, Noble JA, Lane JA, Mack SJ, Atkinson MA, Azad K, Wasserfall CH, Ogle GD. Clinical features, biochemistry and HLA-DRB1 status in children and adolescents with diabetes in Dhaka, Bangladesh. Diabetes Res Clin Pract 2019; 158:107894. [PMID: 31669629 PMCID: PMC6988504 DOI: 10.1016/j.diabres.2019.107894] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
AIMS Little information is published on diabetes in young people in Bangladesh. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting Bangladeshi children and adolescents <22 years of age. METHODS The study was conducted at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM) in Dhaka. One hundred subjects aged <22 years at diagnosis were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C-peptide, and autoantibodies against glutamic acid decarboxylase 65 (GADA) and islet antigen-2 (IA-2A) were measured. High-resolution DNA genotyping was performed for HLA-DRB1. RESULTS Eighty-four subjects were clinically diagnosed as type 1 diabetes (T1D), seven as type 2 diabetes (T2D), and nine as fibrocalculous pancreatic disease (FCPD). Of the 84 with T1D, 37 (44%) were males and 47 (56%) females, with median age at diagnosis 13 years (y) (range 1.6-21.7) and peak age at onset 12-15 years. 85% of subjects were assessed within one month of diagnosis and all within eleven months. For subjects diagnosed with T1D, mean C-peptide was 0.46 ± 0.22 nmol/L (1.40 ± 0.59 ng/mL), with 9 (10.7%) IA-2A positive, 22 (26%) GADA positive, and 5 (6%) positive for both autoantibodies. Analysis of HLA-DRB1 genotypes revealed locus-level T1D association (p = 6.0E-05); DRB1*04:01 appeared predisposing (p < 3.0E-06), and DRB1*14:01 appeared protective (p = 1.7E-02). CONCLUSIONS Atypical forms of T1D appear to be more common in young people in Bangladesh than in European populations. This will be helpful in guiding more specific assessment at onset and potentially, expanding treatment options.
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Affiliation(s)
- Bedowra Zabeen
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Denira Govender
- Life for a Child Program, Diabetes NSW, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, NSW 2006, Australia.
| | - Zahid Hassan
- Dept of Physiology and Molecular Biology, Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, Bangladesh & Dept of Physiology, Tairunnessa Memorial Medical College, Gazipur, Bangladesh.
| | | | - Julie A Lane
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Steven John Mack
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Mark Alvin Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Kishwar Azad
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh.
| | - Clive Henry Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Graham David Ogle
- Sydney Medical School, University of Sydney, NSW 2006, Australia; Diabetes NSW, Sydney, Australia.
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Alaqeel AA. Pediatric diabetes in Saudi Arabia: Challenges and potential solutions. A review article. Int J Pediatr Adolesc Med 2019; 6:125-130. [PMID: 31890836 PMCID: PMC6926216 DOI: 10.1016/j.ijpam.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/28/2019] [Indexed: 01/27/2023]
Abstract
Diabetes in children has increased globally, and the World Health Organization ranks Saudi Arabia 7th in prevalence and 5th in incidence of type 1 diabetes (T1D). Type 2 diabetes (T2D) in children and adolescents has been identified in Saudi Arabia but its prevalence is still unknown. Despite advances in diabetes management including new insulins, insulin delivery systems, glucose monitoring and easy access to media for disease awareness, diabetes in children continues to be challenging in many aspects. Problems include delayed diagnosis, suboptimal glycemic control, early and late disease complications, transition from pediatric to adult care and raising of obesity and T2D, poor psychological and school support. This review summarizes the pediatric and adolescent diabetes studies in Saudi Arabia to date and explores the country-specific treatment challenges and potential solutions.
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68
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Ampt A, van Gemert T, Craig ME, Donaghue KC, Lain SB, Nassar N. Using population data to understand the epidemiology and risk factors for diabetic ketoacidosis in Australian children with type 1 diabetes. Pediatr Diabetes 2019; 20:901-908. [PMID: 31291024 DOI: 10.1111/pedi.12891] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/18/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Children with type 1 diabetes (T1D) are at risk of diabetic ketoacidosis (DKA) at T1D diagnosis and/or subsequently. OBJECTIVE The objective is to determine the incidence and prevalence of T1D by the presence of DKA and identify the characteristics of subsequent DKA episodes. SUBJECTS The study population included all children aged <15 years with T1D during a hospital/day-stay admission in New South Wales, Australia, from 1 January 2001 to 31 December 2013. T1D and DKA were identified using International Classification of Diseases Australian Modification codes. METHODS Data sources included routinely collected longitudinally linked population hospitalization and birth records. Chi-squared analyses, logistic, and multinomial regression were used to determine the association between child characteristics and admissions with and without DKA. RESULTS The point prevalence of T1D among 0-14-year olds on 31 December 2013 was 144.2 per 100 000. For children aged 0-12 years, the incidence of T1D was 16.3 per 100 000 child-years. One-third had DKA at T1D diagnosis and were more likely to be readmitted with DKA than those without DKA at T1D diagnosis. Children with more than one readmission for DKA were more likely to be female, reside in an inner regional area or an area of socioeconomic disadvantage, and be Australian-born. Among all hospitalizations of children with T1D, those with DKA were more likely to be aged 10-14 years, require intensive care, have longer length of stay, and admitted outside school days. CONCLUSION Routinely collected administrative health data are a reliable source to monitor incidence and health service use of childhood T1D. Children at risk of repeated DKA, particularly females, adolescents, and those from inner regional or socioeconomically disadvantaged areas, should be targeted during education and follow-up.
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Affiliation(s)
- Amanda Ampt
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tegan van Gemert
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,School of Women's and Children's Health, The University of New South Wales, Kensington, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Samantha B Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
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69
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Dhatariya KK. Defining and characterising diabetic ketoacidosis in adults. Diabetes Res Clin Pract 2019; 155:107797. [PMID: 31344382 DOI: 10.1016/j.diabres.2019.107797] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
AIMS Diabetic ketoacidosis (DKA) remains one of the most frequently encountered diabetes related emergencies, and despite updates in management and increasing standardisation of care, still has an appreciable morbidity and mortality. This review focusses on the pathophysiology and epidemiology of DKA, but also on the importance of having a standardised definition. METHODS Relevant data were reviewed where there was available basic science or clinical papers published in peer-reviewed international journals on DKA. These included consensus documents and national or international guidelines. RESULTS The prevalence of DKA varies around the world, but part of this could be down to the way the condition is defined. Examples of this difference include the recent studies on sodium glucose co-transporter inhibitors in people with type 1 and type 2 diabetes which have all been associated with increased rates of DKA, but have highlighted how differences in definitions can make comparisons between agents very difficult. CONCLUSIONS DKA should only be diagnosed when all three components are present - the 'D', the 'K' and the 'A'. In addition, the definitions used to diagnose DKA should be standardised - in particular for clinical trials.
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Affiliation(s)
- Ketan K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK; Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
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Al Shaikh A, Farahat F, Saeedi M, Bakar A, Al Gahtani A, Al-Zahrani N, Jaha L, Aseeri MA, Al-Jifree HM, Al Zahrani A. Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western Saudi Arabia: 11-year experience. J Pediatr Endocrinol Metab 2019; 32:857-862. [PMID: 31271557 DOI: 10.1515/jpem-2018-0548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/13/2019] [Indexed: 11/15/2022]
Abstract
Background A wide range of reports on the incidence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in children have been published worldwide. Reports from Saudi Arabia are limited. The aim of this study was to assess the incidence, clinical pattern and severity of DKA in children with newly diagnosed T1DM and the association of autoimmune conditions with initial DKA occurrence at King Abdulaziz Medical City - Jeddah. Methods This retrospective chart review was conducted during the period 2005-2015. All newly diagnosed T1DM children during the study period were investigated (n = 390). Data were collected on the demographic characteristics, body mass index (BMI), DKA severity, length of hospital stay and follow-up data on the type of diabetes therapy. Results The incidence of DKA among newly diagnosed T1DM pediatric patients was 37.7% (n = 147). Moderate and severe DKA cases were significantly higher among female children (p = 0.04). Patients diagnosed with DKA had lower BMI (20.87 ± 5.21) than their counterparts (p = 0.03). The median length of hospital stay was higher among severe DKA compared to moderate and mild cases (5.0, 4.5 and 4.0 days, respectively). Conclusions The incidence of DKA among newly diagnosed T1DM is still high compared to developed countries; however, it is relatively lower than previous reports in Saudi Arabia. Immediate interventions, such as awareness campaigns, are vital to reduce the burden of this preventable health sequela among children with DM.
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Affiliation(s)
- Adnan Al Shaikh
- King Abdulaziz Medical City, Department of Pediatrics, Division of Pediatric Endocrinology, P.O. Box 9515, Jeddah 21423, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Fayssal Farahat
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammad Saeedi
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ayman Bakar
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Amal Al Gahtani
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Noura Al-Zahrani
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Leena Jaha
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed A Aseeri
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hatim M Al-Jifree
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdullah Al Zahrani
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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71
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Mencher SR, Frank G, Fishbein J. Diabetic Ketoacidosis at Onset of Type 1 Diabetes: Rates and Risk Factors Today to 15 Years Ago. Glob Pediatr Health 2019; 6:2333794X19870394. [PMID: 31453269 PMCID: PMC6696834 DOI: 10.1177/2333794x19870394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is a serious, potentially lethal complication of type 1 diabetes mellitus that may be present at diagnosis. The aim of this study was to determine factors associated with presentation in DKA in new-onset youth and compare the rate of DKA and risk factors to a similar study 15 years prior. This study was a retrospective chart review of newly diagnosed patients with type 1 diabetes mellitus from 2010 to 2013. Of the 276 patients, 29% presented in DKA, compared with 38% 15 years prior (P < .002). Those with Medicaid, those misdiagnosed at initial encounter, and those not evaluated by a pediatrician initially were more likely to present in DKA (P = .002, P = .002, P < .001, respectively). The diagnosis of diabetes was not elicited in one third of patients who ultimately presented in DKA. Pediatricians should be reeducated to ask about polyuria and polydipsia in routine encounters. Furthermore, public awareness initiatives are needed to reduce late presentation in DKA.
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Affiliation(s)
| | - Graeme Frank
- Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Joanna Fishbein
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
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72
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Vicinanza A, Messaaoui A, Tenoutasse S, Dorchy H. Diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: Role of demographic, clinical, and biochemical features along with genetic and immunological markers as risk factors. A 20-year experience in a tertiary Belgian center. Pediatr Diabetes 2019; 20:584-593. [PMID: 31038262 DOI: 10.1111/pedi.12864] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/19/2019] [Accepted: 04/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes (T1D). Little is known about the association between genetic and immunological markers and the risk for DKA at onset of T1D. The aim of this study was to create a model foreseeing the onset of DKA in newly diagnosed patients. METHODS This retrospective study included 532 T1D children (aged <18 years at diagnosis) recruited in our hospital, from 1995 to 2014. DKA and its severity were defined according to the criteria of ISPAD. Genetic risk categories for developing T1D were defined according to the Belgian Diabetes Registry. Multivariate statistical analyses were applied to investigate risk factors related to DKA at diagnosis. RESULTS Overall 42% of patients presented DKA at diagnosis. This study outlined the major risk of DKA at diagnosis for younger children (<3 years) and for those belonging to ethnic minorities. Children carrying neutral genotypes had a 1.5-fold increased risk of DKA at diagnosis than those with susceptible or protective genotypes, a paradoxical observation not previously reported. Only solitary positive IA-2A increased the risk of DKA at diagnosis. The proposed model could help to predict the probability of DKA in 70% of newly diagnosed cases. CONCLUSIONS This was the first reported implication of IA-2A positivity and neutral genotypes predisposing to DKA at diagnosis regardless of its severity. Earlier diagnosis through genetic and immunological screening of high-risk children could decrease DKA incidence at diabetes onset.
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Affiliation(s)
- Alfredo Vicinanza
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Pediatric Intensive Care Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Anissa Messaaoui
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvie Tenoutasse
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Harry Dorchy
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
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73
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Muñoz C, Floreen A, Garey C, Karlya T, Jelley D, Alonso GT, McAuliffe-Fogarty A. Misdiagnosis and Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: Patient and Caregiver Perspectives. Clin Diabetes 2019; 37:276-281. [PMID: 31371859 PMCID: PMC6640891 DOI: 10.2337/cd18-0088] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IN BRIEF Diabetic ketoacidosis (DKA) is a life-threatening complication that frequently occurs at diagnosis of type 1 diabetes, occurs more commonly when a patient is misdiagnosed, is the leading cause of death in children with type 1 diabetes, and is associated with worse long-term outcomes. Our retrospective online survey found that 25% of all participants were misdiagnosed and that misdiagnosis was associated with an 18% increased risk for DKA compared to those correctly diagnosed. Adult providers should consider type 1 diabetes when diagnosing type 2 diabetes, and pediatric providers should rule out type 1 diabetes when a patient reports nonspecific viral symptoms.
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Affiliation(s)
- Cynthia Muñoz
- University of Southern California (USC) Keck School of Medicine, Los Angeles, CA
- USC UCEDD & Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | | | - Tom Karlya
- Diabetes Research Institute Foundation, Hollywood, FL
| | - David Jelley
- Harold Hamm Diabetes Center, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - G. Todd Alonso
- Barbara Davis Center, University of Colorado, Aurora, CO
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74
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Hadgu FB, Sibhat GG, Gebretsadik LG. Diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Tigray, Ethiopia: retrospective observational study. Pediatric Health Med Ther 2019; 10:49-55. [PMID: 31191086 PMCID: PMC6536121 DOI: 10.2147/phmt.s207165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Diabetic ketoacidosis (DKA) is the most severe acute complication of type 1 diabetes mellitus which results in increased risk of morbidity and mortality especially in developing countries. Objective: To assess prevalence and associated factors of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in hospitals of the Tigray region, Ethiopia. Methods: A facility based retrospective observational study design was conducted in newly diagnosed type 1 diabetic children and adolescents up to the age of 18 years who were registered in 13 general and two referral hospitals from January 1, 2013 to December 30, 2017. The diagnosis of diabetic ketoacidosis was made with the criteria below, Children presenting with polysymptoms, weight loss, vomiting, dehydration, and also the indirect signs or effects of acidosis on respiratory and central nervous systems like Kussmaul breathing, lethargy or coma and biochemically random blood sugar level >11 ml/L, glucosuria and urine ketone >+1 and diagnosed with type 1 diabetes for the first time. Descriptive, Mann-Whitney U and logistic regression analysis were carried out to describe and identify the associated factors with diabetic ketoacidosis. Results: More than three-quarters, 258/328 (78.7%) of the newly diagnosed type 1 diabetes patients, presented with diabetic ketoacidosis at initial diagnosis. Median age of diabetic ketoacidosis patients was 11 years. The patients with diabetic ketoacidosis were younger than nondiabetic ketoacidosis patients (11 vs 13 years, P=0.002). The mortality rate of diabetic ketoacidosis was 4.3%. Young age, presence of precipitating factors and symptoms of DKA/diabetes were found to be highly associated with diabetic ketoacidosis at initial diagnosis. Conclusions: The prevalence of diabetic ketoacidosis was alarmingly high. Young age group patients, precipitating factors and the presence of symptoms of diabetes/DKA like excessive drinking, vomiting and fatigue were highly associated with diabetic ketoacidosis.
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Affiliation(s)
- Fikaden Berhe Hadgu
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Gereziher Gebremedhin Sibhat
- Department of Pharmacognocy, School of Pharmacy, College of Health Sciences, Mekelle University, Tigray, Ethiopia
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75
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Wales J, Yates J. Peer review of rural and tertiary Queensland paediatric diabetes services: A pilot project from the National Health Service. J Paediatr Child Health 2019; 55:701-706. [PMID: 30375080 DOI: 10.1111/jpc.14281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
AIM Peer review is one component of the improvement of diabetes care delivered by the National Health Service (NHS) in England and Wales. Queensland has a decentralised model of service provision with an established state diabetes network. METHODS The NHS scheme was adapted for use in Australia, and seven trained reviewers were recruited to visit 14 'hub' centres, which in turn covered 29 'spoke' units delivering care to over 95% of all public patients <16 years old in the state. Details of control as measured by glycosylated haemoglobin (HbA1c), the rate of presentation of diabetic ketoacidosis (DKA), the use of state guidance and staffing levels were recorded. Thirteen minimum standards of care were used as a basis for assessment. A report for the use of each inspected unit was produced at the end of the process. RESULTS Most units had not previously collected outcome data; 45% of new cases presented with DKA. The centre mean HbA1c was 9.1%, and only 21% of patients achieved the Australian recommended level of <7.5%. Only three centres met some of the internationally recommended staffing levels. Only two centres provided transitional care to adult services. Of 13 NHS minimum standards of care, a mean of 5 were achieved (range 1-8), a mean of 4.6 partially achieved (range 3-6) and a mean of 3.9 not achieved (range 0-9). The care for 68 patients with type 2 diabetes was particularly poor. CONCLUSIONS Paediatric diabetes care in Queensland is suboptimal. Recommended remedial actions are suggested that may be applicable to other states.
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Affiliation(s)
- Jerry Wales
- Department of Endocrinology, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jason Yates
- Department of Paediatrics, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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76
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Townson J, Cannings-John R, Francis N, Thayer D, Gregory JW. Presentation to primary care during the prodrome of type 1 diabetes in childhood: A case-control study using record data linkage. Pediatr Diabetes 2019; 20:330-338. [PMID: 30737875 DOI: 10.1111/pedi.12829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate primary care presentations during the prodrome (12 months prior to onset type-1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis. METHODS This was a case-control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA. RESULTS A total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047). CONCLUSION There are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA.
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Affiliation(s)
- Julia Townson
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Nick Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dan Thayer
- SAIL Databank, School of Medicine, Swansea University, Swansea, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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77
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Féki I, Turki M, Zitoun I, Sellami R, Baati I, Masmoudi J. [Depression and coping strategies in the elderly with type 2 diabetes]. L'ENCEPHALE 2019; 45:320-326. [PMID: 30885441 DOI: 10.1016/j.encep.2019.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/15/2019] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Elderly patients with diabetes have been shown to have more diabetes-related complications, and they are more likely to develop somatic and psychiatric comorbidities including cognitive dysfunction and depression. Several studies have shown a close association between diabetes and depression. This comorbidity may lead to functional disability and quality of life deterioration. Thus, the elderly will face various constraints through the coping strategies. In this context, we conducted our study to assess the prevalence of depressive symptoms in elderly patients with diabetes as well as its associated factors, and to investigate their coping strategies. METHODS We conducted a cross-sectional, descriptive and analytic study among 50 elderly patients (age≥65 years) being followed for type 2 diabetes at the outpatient department for chronic diseases of the Regional Hospital of Aguereb, Sfax, Tunisia. We used the "Activity of Daily Living" to assess the dependence level, the "Geriatric Depression Scale" to screen for depressive symptoms, and the "Brief Coping with Problems Experienced" to investigate the coping strategies. RESULTS The mean age of patients was 73.3 years, with a sex-ratio (M/F) of 0.62. Smoking and alcohol consumption were reported respectively in 20% and 4% of participants. The mean duration of diabetes was 7.7 years. Diabetes complications were noted in 70% of participants. Somatic comorbidities were noted in 94% of cases (hypertension 84%; dyslipidemia 34%). Psychiatric histories were reported in 18% of patients who suffered from anxio-depressive symptoms. No patient among those with mental disorder histories benefited from any psychiatric management prior to the study. Three patients (6%) had previously presented suicidal ideations but none of them had attempted suicide. The mean "Activity of Daily Living" score was 4.9 points. Patients were autonomous in 28%, and dependent in 4% of cases. The mean "Geriatric Depression Scale" score was 9.8 points. According to this scale, the prevalence of depressive symptoms was 34%. They were correlated with: smoking (P=0.04), psychiatric histories (P=0.031), absence of leisure activity (P=0.035), "Activity of Daily Living" score (P=0.028), long duration of diabetes (P=0.04) and the presence of suicidal ideation (P=0.013). According to the « Brief Coping with Problems Experienced », the problem-focused coping strategies were the most frequently used (44%), followed by emotion-focused (38%) and passive strategies (18%). Participants with depressive symptoms are significantly more likely to adopt emotion-focused coping strategies (P=0.01). CONCLUSION Our study highlighted a high prevalence of depressive symptoms among elderly patients with diabetes. This relationship seems to be bi-directional and may increase somatic complications and alter the quality of life, and then darken the prognosis. Thus, besides pharmacological treatment, regular depression screening and psychological support are essential to ensure a better control of diabetes and to improve well-being.
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Affiliation(s)
- I Féki
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - M Turki
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - I Zitoun
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - R Sellami
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - I Baati
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - J Masmoudi
- Service de psychiatrie « A », CHU Hédi Chaker, 3029 Sfax, Tunisie
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Fawwad A, Govender D, Ahmedani MY, Basit A, Lane JA, Mack SJ, Atkinson MA, Henry Wasserfall C, Ogle GD, Noble JA. Clinical features, biochemistry and HLA-DRB1 status in youth-onset type 1 diabetes in Pakistan. Diabetes Res Clin Pract 2019; 149:9-17. [PMID: 30710658 PMCID: PMC6456725 DOI: 10.1016/j.diabres.2019.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/10/2018] [Accepted: 01/15/2019] [Indexed: 01/17/2023]
Abstract
Published information on diabetes in Pakistani youth is limited. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting children and adolescents <22 years of age. The study was conducted at Baqai Institute of Diabetology and Endocrinology in Karachi from June 2013-December 2015. One hundred subjects aged <22 years at diagnosis were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C-peptide, glutamic acid decarboxylase 65 (GAD65) and islet antigen 2 (IA-2) autoantibodies) were measured. DNA from 100 subjects and 200 controls was extracted and genotyped for HLA-DRB1 using high-resolution genotyping technology. Ninety-nine subjects were clinically diagnosed as type 1 diabetes (T1D) and one as type 2 diabetes (T2D). Of the 99 with T1D, 57 (57.6%) were males and 42 (42.4%) females, with mean age at diagnosis 11.0 ± 5.2 years (range 1.6-21.7 years) and peaks at six and fifteen years. Fifty-seven subjects were assessed within one month of diagnosis and all within eleven months. For the subjects diagnosed as T1D, mean C-peptide was 0.63 ± 0.51 nmol/L (1.91 ± 1.53 ng/mL), with 16 (16.2%) IA2 positive, 53 (53.5%) GAD-65 positive, and 10 (10.1%) positive for both autoantibodies. In T1D patients, the allele DRB1*03:01 demonstrated highly significant T1D association (p < 10-16), with no apparent risk conferred by DRB1*04:xx alleles. CONCLUSIONS: Heterogeneous forms of T1D appear more common in children and youth in Pakistan than in European populations. Individual understanding of such cases could enable improved management strategies and healthier outcomes.
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Affiliation(s)
- Asher Fawwad
- Biochemistry Department, Baqai Medical University, Gadap, Karachi, Pakistan; Baqai Institute of Diabetology and Endocrinology, Nazimabad, Karachi, Pakistan.
| | - Denira Govender
- Life for a Child, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, NSW 2006, Australia.
| | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology, Nazimabad, Karachi, Pakistan.
| | - Julie Ann Lane
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Steven John Mack
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Mark Alvin Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Clive Henry Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Graham David Ogle
- Life for a Child, Glebe, NSW 2037, Australia; Diabetes NSW, Sydney, Australia.
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Saraswathi S, Al-Khawaga S, Elkum N, Hussain K. A Systematic Review of Childhood Diabetes Research in the Middle East Region. Front Endocrinol (Lausanne) 2019; 10:805. [PMID: 31824422 PMCID: PMC6882272 DOI: 10.3389/fendo.2019.00805] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Diabetes mellitus (DM) is a common chronic disorder in children and is caused by absolute or relative insulin deficiency, with or without insulin resistance. There are several different forms of childhood DM. Children can suffer from neonatal diabetes mellitus (NDM), type 1 diabetes (T1DM), type 2 diabetes (T2DM), Maturity Onset Diabetes of the Young (MODY), autoimmune monogenic, mitochondrial, syndromic and as yet unclassified forms of DM. The Middle East has one of the highest incidences of several types of DM in children; however, it is unclear whether pediatric diabetes is an active area of research in the Middle East and if ongoing, which research areas are of priority for DM in children. Objectives: To review the literature on childhood DM related to research in the Middle East, summarize results, identify opportunities for research and make observations and recommendations for collaborative studies in pediatric DM. Methods: We conducted a thorough and systematic literature review by adhering to a list recommended by PRISMA. We retrieved original papers written in English that focus on childhood DM research, using electronic bibliographic databases containing publications from the year 2000 until October 2018. For our final assessment, we retrieved 429 full-text articles and selected 95 articles, based on our inclusion and exclusion criteria. Results: Our literature review suggests that childhood DM research undertaken in the Middle East has focused mainly on reporting retrospective review of case notes, a few prospective case studies, systemic reviews, questionnaire-based studies, and case reports. These reported studies have focused mostly on the incidence/prevalence of different types of DM in childhood. No studies report on the establishment of National Childhood Diabetes Registries. There is a lack of consolidated studies focusing on national epidemiology data of different types of childhood DM (such as NDM, T1DM, T2DM, MODY, and syndromic forms) and no studies reporting on clinical trials in children with DM. Conclusions: Investing in and funding basic and translational childhood diabetes research and encouraging collaborative studies, will bring enormous benefits financially, economically, and socially for the whole of the Middle East region.
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Affiliation(s)
- Saras Saraswathi
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Sara Al-Khawaga
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Naser Elkum
- Biostatistics Section, Clinical Research Center, Research Services, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
- *Correspondence: Khalid Hussain
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Oko APG, Ali FKZ, Mandilou SVM, Kambourou J, Letitia L, Poathy JPY, Engoba M, Ndjobo MIC, Monabeka HG, Moyen GM. [Diabetic ketoacidosis in children: epidemiological and prognostic aspects]. Pan Afr Med J 2018; 31:167. [PMID: 31086620 PMCID: PMC6488241 DOI: 10.11604/pamj.2018.31.167.14415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 10/08/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In Congo, data on diabetic ketoacidosis (DKA) in children are old and rare. This study aims to describe the sociodemographic features of DKA and to identify risk factors for mortality. PATIENTS AND METHODS We conducted an analytical study on DKA in childred at the University Hospital in Brazzaville over the period from January 2013 to June 2016. We examined the socio-demographic, clinical, paraclinical and evolutionary variables. Chi-Square Test, Fisher's exact test and odds ratio were used in the univariate analysis process and logistic regression model in the multivariate analysis. RESULTS Out of 172 children hospitalized with diabetes 55 (31%) were hospitalized with ketoacidosis. They were girls (33; 60%) with an average age of 11.1± 4.9 years (ranging from 1 months to 17 years), 61.8% of parents came from low socioeconomic status. Ketoacidosis was the revealing symptom in 67.2 % of cases. The diagnosis made before hospitalization was wrong (50%). The triggering factor was often an infection (52.7%). Mortality rate was 12.7%. The risk factors for mortality in the univariate analysis were: age < 5 years (p=0,000006), average consultation time higher than 7 days (p= 0.001), severe dehydration (p = 0.0006), hemodynamic disorders (p= 0.0006), severe undernutrition (p= 0.02), Glasgow Coma Scale < 9 (p= 0.007) and diarrhea (p= 0.001). CONCLUSION The importance and the seriousness of ketoacidosis impose preventive measures based on awareness, information and education campaigns as well as on the management of risk factors for mortality.
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Affiliation(s)
- Aymar Pierre Gildas Oko
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo
- Service de Soins Intensifs Pédiatriques, CHU de Brazzaville, République du Congo
| | | | | | - Judicaël Kambourou
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo
- Service de Soins Intensifs Pédiatriques, CHU de Brazzaville, République du Congo
| | - Lombet Letitia
- Service de Soins Intensifs Pédiatriques, CHU de Brazzaville, République du Congo
| | | | - Moyen Engoba
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo
- Service de Soins Intensifs Pédiatriques, CHU de Brazzaville, République du Congo
| | | | - Henri Germain Monabeka
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo
- Service de Maladies Métaboliques et d'Endocrinologie, BP 32, République du Congo
| | - Georges Marius Moyen
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo
- Service de Soins Intensifs Pédiatriques, CHU de Brazzaville, République du Congo
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81
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Derraik JGB, Cutfield WS, Maessen SE, Hofman PL, Kenealy T, Gunn AJ, Jefferies CA. A brief campaign to prevent diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: The NO-DKA Study. Pediatr Diabetes 2018; 19:1257-1262. [PMID: 30014558 DOI: 10.1111/pedi.12722] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/07/2018] [Accepted: 07/02/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE New-onset diabetic ketoacidosis (NO-DKA) is entirely preventable with early recognition of the symptoms of type 1 diabetes mellitus (T1D). In this study, we aimed to assess whether a simple and easily delivered educational campaign could reduce the risk of DKA. METHODS A poster highlighting key features of new-onset T1D was delivered once a year over 2 years to mailboxes of over 460 000 individual residential households in the Auckland region (New Zealand). In the first year, the campaign poster was also delivered to all general practices in the region. Families of all newly diagnosed cases of T1D in children answered a brief questionnaire to ascertain whether the campaign reached them. RESULTS Over the 24-month period covered by this study, 132 new cases of T1D were diagnosed in children and adolescents in Auckland. There were 38 cases (28.8%) of DKA, which is similar to the average over the previous 5-year period (27.0%). The caregivers of three children reported both seeing the campaign poster and seeking medical attention as a result. None of these three children were in DKA at diagnosis; they were aged 6.3 to 9.7 years, and of New Zealand European ethnicity. CONCLUSIONS A non-targeted campaign to raise awareness of diabetes symptoms in youth led only a few caregivers to seek timely medical attention. Overall, this once-yearly untargeted campaign to raise awareness of diabetes symptoms in youth had limited impact. More effective strategies are required, possibly involving sustained targeted education of medical practitioners.
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Affiliation(s)
- José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Sarah E Maessen
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Timothy Kenealy
- Liggins Institute, University of Auckland, Auckland, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Craig A Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
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82
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Martins KAKF, Mascarenhas LPG, Morandini M, Cat MNL, Pereira RM, Carvalho JRD, Lacerda Filho LD, França SN. Health-related quality of life in a cohort of youths with type 1 diabetes. Rev Assoc Med Bras (1992) 2018; 64:1038-1044. [DOI: 10.1590/1806-9282.64.11.1038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/24/2018] [Indexed: 12/17/2022] Open
Abstract
SUMMARY Health-related quality of life (HRQOL) in type 1 diabetes mellitus (T1DM) has been widely studied. The objectives of this study were to evaluate and identify the factors influencing the HRQOL of children and adolescents with T1DM. MATERIAL AND METHODS: In total, 59 patients (9–16 years, T1DM for ≥1 year) responded to a version of the Diabetes Quality of Life Instrument for Youth (DQOLY) adapted to adapted to Brazilian patients, the Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD). This instrument comprises 50 items (domains satisfaction, impact, and concerns, with the lowest scores corresponding to better HRQOL) and a questionnaire gathering social, demographic, and clinical parameters. RESULTS: The mean age of the patients was 13.6 years, and 57.6% were girls. The median age at diagnosis was 7.16 years, 63% presented diabetic ketoacidosis (DKA) at diagnosis and 29% during follow-up. Mean glycated hemoglobin (HbA1c) in the previous year was 10%. All patients administered multiple insulin doses (mean 4.2 applications/day), 74.5% used rapid-acting and intermediate-acting insulin analogs, and 67.8% used pens for insulin application. The results of the DQOLY were within the cutoff limit for better HRQOL. An isolated analysis of each domain and the questionnaire results showed that the following factors were associated with better HRQOL: height Z-score, lower HbA1c, practice of physical activity, use of pen, fewer hospitalizations, and residence in a rural area. There was a high DKA rate at diagnosis, and the metabolic control was inappropriate in most patients. Despite coming from low-income households, most patients had access to the recommended treatment. CONCLUSION: Among T1DM patients, 71% had IQVJD scores compatible with better HRQOL.
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83
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Alduaij AA, Alhamad D, Schatz P. Unilateral central retinal vein occlusion as a first manifestation of diabetes mellitus in a ten-year-old girl. Saudi J Ophthalmol 2018; 32:346-348. [PMID: 30581309 PMCID: PMC6300750 DOI: 10.1016/j.sjopt.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 11/23/2022] Open
Abstract
Central retinal vein occlusion (CRVO) is relatively rare in the pediatric age group. We present a case of CRVO as the first manifestation of diabetes mellitus in a ten-year-old girl. The associated macular edema was managed successfully with a single injection of Ranibizumab. Ophthalmologists should consider the possibility of diabetes mellitus in pediatric cases of CRVO.
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84
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Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling MA, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018; 19 Suppl 27:155-177. [PMID: 29900641 DOI: 10.1111/pedi.12701] [Citation(s) in RCA: 364] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California
| | - Michael Agus
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.,Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla and Sahlgrenska Academy, Gothenburg University, Uddevalla, Sweden
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Mark A Sperling
- Division of Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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85
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Ahmadov GA, Govender D, Atkinson MA, Sultanova RA, Eubova AA, Wasserfall CH, Mack SJ, Lane JA, Noble JA, Ogle GD. Epidemiology of childhood-onset type 1 diabetes in Azerbaijan: Incidence, clinical features, biochemistry, and HLA-DRB1 status. Diabetes Res Clin Pract 2018; 144:252-259. [PMID: 30218742 PMCID: PMC6384092 DOI: 10.1016/j.diabres.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 01/27/2023]
Abstract
AIMS Determine the incidence and typology of diabetes in children in Azerbaijan. METHODS Clinical features, C-peptide, autoantibodies (glutamic acid decarboxylase 65 (GAD65) and islet antigen 2 (IA-2)), and HLA-DRB1 status were studied in 106 subjects <18 years of age who were recently diagnosed. 104 cases were consecutive. Incidence was determined for Baku and Absheron regions, where ascertainment is estimated to be essentially 100%. RESULTS 104 of the 106 (98%) were diagnosed with type 1 diabetes, one with type 2 diabetes and one with atypical diabetes. Type 1 diabetes incidence in Baku City and Absheron was 7.05 per 100,000 population <15 years per year. Peak age of onset was 10 years. There was a slight male preponderance (male:female 1.17:1), and no temporal association with seasons. Almost all type 1 diabetes subjects presented with classic symptoms including a high incidence (58%) of diabetic ketoacidosis. 86% presented with low C-peptide values (<0.13 nmol/L, <0.40 ng/mL) and 74% were positive for at least one type 1 diabetes-related autoantibody. CONCLUSIONS Azerbaijan has a moderate type 1 diabetes incidence and clinical, biochemical and genetic features similar to that in European populations.
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Affiliation(s)
- Gunduz Ahmad Ahmadov
- Endocrine Centre, Binagadi, Baku City, Azerbaijan; 6th Children's Hospital, Baku City, Azerbaijan; Azerbaijan Medical University, Baku City, Azerbaijan
| | - Denira Govender
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, Sydney 2006, Australia
| | - Mark Alvin Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA
| | | | | | - Clive Henry Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA
| | - Steven John Mack
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | - Julie Ann Lane
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | | | - Graham David Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia; Diabetes NSW, Glebe 2037, NSW, Australia.
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86
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Patwardhan R, Gorton S, Vangaveti VN, Yates J. Diabetic ketoacidosis incidence in children at first presentation of type 1 diabetes at an Australian regional hospital: The effect of health professional education. Pediatr Diabetes 2018; 19:993-999. [PMID: 29484782 DOI: 10.1111/pedi.12666] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is an acute life threatening, resource intensive preventable complication of type 1 diabetes which has major biopsychosocial effects on patients and families. Incidence of pediatric DKA has been studied nationally and internationally in metropolitan centers. This study analyzed the DKA incidence at first presentation of type 1 diabetes at Townsville Hospital, before and after an educational intervention. This is the first study of its kind in a regional center in Queensland, Australia. METHOD The inclusion criteria consisted of children (0-18 years) diagnosed with type 1 diabetes from January, 2006 to December, 2016. Medical and laboratory patient data was retrospectively collected. Quantitative analysis was conducted using SPSS. Education sessions were delivered to health professionals by a pediatric endocrinologist during 2015 and 2016. DKA and its severity were defined by the International Society of Pediatric Diabetes 2014 Guidelines. RESULTS In total, 106 patients met inclusion criteria. Average incidence of DKA at first presentation of type 1 diabetes was 48.10%. Pre- and post-intervention incidences were 54.90% and 25%, respectively (P = 0.01). DKA severity pre- and post-intervention were severe (48.88%, 33.33%), moderate (26.67%, 16.67%), and mild (24.44%, 50%), respectively (P = 0.53). CONCLUSIONS DKA incidence at first presentation of type 1 diabetes prior to intervention, is higher than that reported by other studies in Australia: Brisbane (31.8%) and Sydney (37.7%). DKA incidence at first presentation of type 1 diabetes decreased significantly during the period of health professional education.
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Affiliation(s)
- Radhika Patwardhan
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Susan Gorton
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Venkat N Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jason Yates
- Paediatric Unit, The Townsville Hospital, Townsville, Queensland, Australia
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87
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Ziegler A, Williams T, Yarid N, Schultz DL, Bundock EA. Fatalities Due to Failure of Continuous Subcutaneous Insulin Infusion Devices: A Report of Six Cases. J Forensic Sci 2018; 64:275-280. [PMID: 29940703 DOI: 10.1111/1556-4029.13841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.
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Affiliation(s)
- Andrew Ziegler
- Boston University School of Medicine, Department of Anatomy & Neurobiology, Program of Biomedical Forensic Sciences, 72 E Concord Street, Boston, MA, 02118
| | - Timothy Williams
- King County Medical Examiner's Office, 908 Jefferson Street, Seattle, WA, 98104
| | - Nicole Yarid
- Erie County Medical Examiner, 501 Kensington Avenue, Buffalo, NY, 14214
| | - Daniel L Schultz
- District 12 Medical Examiner Office, 2001 Siesta Drive #302, Sarasota, FL, 34231
| | - Elizabeth A Bundock
- Office of the Chief Medical Examiner, 111 Colchester Ave # 1, Burlington, VT, 05401
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88
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Odeh R, Alassaf A, Ajlouni K. Clinical and biochemical features at diagnosis of type 1 diabetes in patients between 0 and 18 years of age from Jordan. Pediatr Diabetes 2018; 19:707-712. [PMID: 29280234 DOI: 10.1111/pedi.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Data regarding type 1 diabetes mellitus (T1D) in Jordan are extremely scarce. We aim to evaluate the clinical and laboratory characteristics at diagnosis of T1D in a group of children from Jordan. METHODS The records of 437 (boys/girls: 224/213) children with type 1 diabetes followed in the years 2012 to 2016 were evaluated retrospectively. The data were assessed by sex and age subgroups (<5, 6-10, and 11-18 years). RESULTS Mean age of children at diagnosis was 7.3 ± 3.6 years. The first peak in the number of T1D cases in terms of age at diagnosis was observed in the age group between 6 and 8 years (n = 116 [26.5%], 95% confidence interval [CI]: 22.3%-30.6%). This was followed by the age group of 3 to 5 years (n = 108 [24.7%], 95% CI: 20.6%-28.7%). Although the patients mostly presented in winter (30.0%, 95% CI: 25.6%-34.3%), no season-related significant differences were found. The frequency of ketoacidosis at diagnosis was 40.7% (95% CI: 36%-45.3%). At presentation, 22.8% (95% CI: 18.9%-26.7) of our patients had a positive history of T1D in their extended families. In addition, 61.1% (95% CI: 56.5%-65.7%) of the patients were started on premixed insulin at diagnosis. CONCLUSION The findings possibly indicate a decreasing age of T1D onset in Jordanian patients. The high frequency of ketoacidosis at presentation is noteworthy. In addition, the initial insulin protocols are not in accordance with the recommended insulin therapy for children and adolescents with T1D.
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Affiliation(s)
- Rasha Odeh
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Abeer Alassaf
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman, Jordan
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89
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Type 1 Diabetes Mellitus in Saudi Arabia: A Soaring Epidemic. Int J Pediatr 2018; 2018:9408370. [PMID: 29853923 PMCID: PMC5964576 DOI: 10.1155/2018/9408370] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/04/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is quite prevalent in the world, with a proportion of 1 in every 300 persons and steadily rising frequency of incidence of about 3% every year. More alarmingly, the incidence of T1DM among infants is also increasing, with children as young as 6 months succumbing to it, instead of that at a rather established vulnerable age of around seven and near puberty, when the hormones antagonize the action of insulin. These reports pose a unique challenge of developing efficient T1DM management system for the young children. The Kingdom of Saudi Arabia (KSA) is the largest country in the Middle East that occupies approximately four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people, of whom 26% are under the age of 14 years. As per the Diabetes Atlas (8th edition), 35,000 children and adolescents in Saudi Arabia suffer from T1DM, which makes Saudi Arabia rank the 8th in terms of numbers of TIDM patients and 4th country in the world in terms of the incidence rate (33.5 per 100,000 individuals) of TIDM. However, in comparison with that in the developed countries, the number of research interventions on the prevalence, incidence, and the sociodemographic aspects of T1DM is woefully inadequate. In this review we discuss different aspects of T1DM in Saudi Arabia drawing on the published literature currently available.
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90
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Deylami R, Townson J, Mann M, Gregory JW. Systematic review of publicity interventions to increase awareness amongst healthcare professionals and the public to promote earlier diagnosis of type 1 diabetes in children and young people. Pediatr Diabetes 2018; 19:566-573. [PMID: 28782293 DOI: 10.1111/pedi.12565] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children with new onset type 1 diabetes (T1D) are at risk of developing the life-threatening condition ketoacidosis if they have a delayed diagnosis. The rate of children presenting in ketoacidosis remains high in a number of countries worldwide. To ensure interventions to raise awareness of symptoms are effective a systematic review was conducted to evaluate previous publicity campaigns. METHODS A range of databases was searched using search terms relating to T1D, publicity campaigns, and symptom awareness. Identified articles were checked against the inclusion criteria, ensuring interventions were designed to target individuals prior to diagnosis of T1D. Papers were independently assessed under the criteria specified within the Critical Appraisal Skills Programme checklist. RESULTS The initial search retrieved 1537 papers and following screening 20 were identified for full consideration. Thirteen did not meet the inclusion criteria, leaving 7 to be assessed. Of these 7, 2 observational case-control studies reported a reduction in the rate of ketoacidosis following a publicity campaign using posters and providing glucose testing equipment to primary healthcare professionals. Four observational cohort studies, utilized posters, and media campaigns; 2 reported a reduction in the rate of ketoacidosis and 2 reported no difference following their interventions. A feasibility study, not designed to evaluate effectiveness, reported some anecdotal evidence of a more timely diagnosis. CONCLUSION Due to the methodological limitations of the studies identified, it is not possible to make a definitive conclusion on the effectiveness of the interventions reported.
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Affiliation(s)
- R Deylami
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - J Townson
- Centre for Trial Research (CTR), Cardiff University, Cardiff, Wales, UK
| | - M Mann
- Specialist Unit for Review Evidence (SURE), Cardiff University, Cardiff, Wales, UK
| | - J W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
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91
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Bravis V, Kaur A, Walkey HC, Godsland IF, Misra S, Bingley PJ, Williams AJK, Dunger DB, Dayan CM, Peakman M, Oliver NS, Johnston DG. Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort. BMJ Open 2018; 8:e020904. [PMID: 29622578 PMCID: PMC5893930 DOI: 10.1136/bmjopen-2017-020904] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive. DESIGN Observational cohort study. SETTING 146 mainly secondary care centres across England and Wales. PARTICIPANTS 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%. MAIN OUTCOME MEASURES Autoantibody status and characteristics at presentation. RESULTS The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01). CONCLUSIONS Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes. TRIAL REGISTRATION NUMBER ISRCTN66496918; Pre-results.
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Affiliation(s)
| | - Akaal Kaur
- Department of Medicine, Imperial College London, London, UK
| | - Helen C Walkey
- Department of Medicine, Imperial College London, London, UK
| | - Ian F Godsland
- Department of Medicine, Imperial College London, London, UK
| | - Shivani Misra
- Department of Medicine, Imperial College London, London, UK
| | - Polly J Bingley
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Mark Peakman
- Department of Immunobiology, King's College London, London, UK
| | - Nick S Oliver
- Department of Medicine, Imperial College London, London, UK
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92
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Al-Ghamdi AH, Fureeh AA. Prevalence and clinical presentation at the onset of type 1 diabetes mellitus among children and adolescents in AL-Baha region, Saudi Arabia. J Pediatr Endocrinol Metab 2018. [PMID: 29537213 DOI: 10.1515/jpem-2017-0059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objectives were to describe the frequency of clinical presentation at the onset of type 1 diabetes mellitus (T1DM) and to estimate the prevalence of T1DM among children and adolescents in the AL-Baha region, Saudi Arabia, aiming for early diagnosis of T1DM. METHODS The clinical and laboratory data of 471 children and adolescents who presented with T1DM and received medical care at an AL-Baha diabetic center during the period from 2007 to 2016 were retrospectively analyzed based on the records. RESULTS The prevalence of T1DM in the AL-Baha region was 355 per 100,000 population in participants aged from 0 to 19 years. T1DM was more common among girls than boys (57.5% vs. 42.5%, respectively; p=0.3), and the female/male ratio was 1.36 in favor of girls. Hyperglycemic symptoms were the most frequent symptoms at presentation [59.2% vs. 40.8% with diabetic ketoacidosis (DKA)], and 37% of them presented with loss of weight. Most of the ketoacidosis was mild to moderate (80.2%), while only 19.8% of children had the severe type and DKA was more common (55.2%) among females. The mean age at diagnosis of T1DM was 8.2±3.5 years for all patients, and 8.3±3.9 and 8.9±3.6 years for boys and girls, respectively (p=0.06). Hyperglycemic symptoms were more common in spring (15.9%). CONCLUSIONS The prevalence of type 1 diabetes in the AL-Baha region was 355 per 100,000 population, which is one of the highest reported prevalences in this age group. Hyperglycemic symptoms were the most encountered symptoms at the onset of the presentation of T1DM and this may help in early detection of diabetic symptoms by patients and physicians to avoid the more severe types of presentation.
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Affiliation(s)
- Ahmed Hassan Al-Ghamdi
- Pediatric Endocrinology, Pediatric Department, AL-Baha College of Medicine, AL-Baha, Kingdom of Saudi Arabia
| | - Abdelhameed Ahmed Fureeh
- AL-Baha College of Medicine, P.O. Box. 1988, AL-Baha, Kingdom of Saudi Arabia, Phone: +966537348524, Fax: +966-17-7247272.,Adult Endocrinology, Internal Medicine Department, Mansoura College of Medicine, Mansoura, Egypt
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93
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Fortunato L, Salzano G. Diabetic ketoacidosis as the onset of type 1 diabetes in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:5-6. [PMID: 29633733 PMCID: PMC6357606 DOI: 10.23750/abm.v89i1.7199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
Not available.
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Affiliation(s)
- Lombardo Fortunato
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
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94
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Jacobsen LM, Haller MJ, Schatz DA. Understanding Pre-Type 1 Diabetes: The Key to Prevention. Front Endocrinol (Lausanne) 2018; 9:70. [PMID: 29559955 PMCID: PMC5845548 DOI: 10.3389/fendo.2018.00070] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/16/2018] [Indexed: 01/08/2023] Open
Abstract
While the incidence of type 1 diabetes continues to rise by 3% each year, the ability to prevent this disease remains elusive. Hybrid closed loop devices, artificial pancreas systems, and continuous glucose monitoring technology have helped to ease the daily burden for many people living with type 1 diabetes. However, the artificial pancreas is not a cure; more research is needed to achieve our ultimate goal of preventing type 1 diabetes. The preceding decades have generated a wealth of information regarding the natural history of pre-type 1 diabetes. Islet autoimmunity in the form of multiple autoantibodies is known to be highly predictive of progression to disease. Staging systems have been devised to better characterize pre-type 1, direct mechanistic understanding of disease, and guide the design of prevention studies. However, there are no evidence-based recommendations for practitioners caring for autoantibody patients other than to encourage enrollment in research studies. Close monitoring of high-risk patients in natural history studies markedly reduces diabetic ketoacidosis rates at diagnosis and research participation is critical to finding a means of preventing type 1 diabetes. The discovery of an effective preventative strategy for type 1 diabetes will justify universal risk screening for all children.
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Affiliation(s)
- Laura M. Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J. Haller
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Desmond A. Schatz
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
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95
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Hekkala AM, Ilonen J, Toppari J, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 diabetes: Effect of prospective studies with newborn genetic screening and follow up of risk children. Pediatr Diabetes 2018; 19:314-319. [PMID: 28544185 DOI: 10.1111/pedi.12541] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 01/10/2023] Open
Abstract
We studied the frequency of diabetic ketoacidosis (DKA) in children at diagnosis of type 1 diabetes (T1D) in a region where newborn infants have since 1995 been recruited for genetic screening for human leukocyte antigen (HLA)-conferred disease susceptibility and prospective follow up. The aim was to study whether participation in newborn screening and follow up affected the frequency of DKA, and to follow the time trends in DKA frequency. We first included children born in Oulu University Hospital since 1995 when the prospective studies have been ongoing and diagnosed with T1D <15 years by 2015 (study cohort 1, n = 517). Secondly, we included all children diagnosed with T1D <15 years in this center during 2002-2014 (study cohort 2, n = 579). Children who had an increased genetic risk for T1D and participated in prospective follow up had low frequency of DKA at diagnosis (5.0%). DKA was present in 22.7% of patients not screened for genetic risk, 26.7% of those who were screened but had not an increased risk and 23.4% of children with increased genetic risk but who were not followed up. In study cohort 2 the overall frequency of DKA was 18.5% (13.0% in children <5 years, 14.0% in children 5-10 years and 28.6% in children ≥10 years at diagnosis; P<.001). In children <2 years the frequency of DKA was 17.1%. Participation in prospective follow-up studies reduces the frequency of DKA in children at diagnosis of T1D, but genetic screening alone does not decrease DKA risk.
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Affiliation(s)
- Anne M Hekkala
- Department of Pediatrics, MRC Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, University of Turku, and Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland.,Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mikael Knip
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Riitta Veijola
- Department of Pediatrics, MRC Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
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96
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von Oettingen JE, Rhodes ET, Wolfsdorf JI. Resolution of ketoacidosis in children with new onset diabetes: Evaluation of various definitions. Diabetes Res Clin Pract 2018; 135:76-84. [PMID: 29111277 PMCID: PMC6013285 DOI: 10.1016/j.diabres.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/22/2017] [Accepted: 09/18/2017] [Indexed: 01/21/2023]
Abstract
AIMS Data are sparse concerning use of serum electrolyte parameters as compared to venous blood gas (VBG) measurements to monitor acid-base status during treatment of diabetic ketoacidosis (DKA). We explored the utility of various parameters to define DKA resolution by investigating the relationship of venous pH (vpH), anion gap (AG), serum bicarbonate (HCO3), and glucose concentration during management of DKA in children with new onset diabetes mellitus (NODM). METHODS We included all patients with NODM presenting with DKA to Boston Children's Hospital from 10/1/07-7/1/13. DKA was defined as serum glucose ≥ 200 mg/dL (11.1 mmol/L) and vpH<7.30; severity as mild <7.30, moderate<7.20, severe<7.10; resolution of DKA as vpH≥7.30 and AG≤18 mmol/L. We used Cox regression to determine time to DKA resolution, and logistic regression to evaluate different serum HCO3 cut-off values as predictors of DKA resolution. RESULTS 263 patients (133F, mean age 9.9±4.4 years, 74% White) were included. DKA was mild in 134 (51%), moderate in 75 (28%) and severe in 54 (20%). In mild DKA, AG closed after normalization of vpH; in moderate and severe DKA, AG closed before normalization of vpH. HCO3>15mmol/L correlated with vpH≥7.30, and had 76% sensitivity and 85% specificity to predict DKA resolution. Median times to DKA resolution were similar using two different definitions: vpH and AG (8.4h [IQR 6.3-11.9]) vs. HCO3>15 mmol/L (7.9 h [IQR 5.0-11.8]), p=.42. CONCLUSIONS During management of pediatric DKA, HCO3 > 15 mmol/L reliably predicts resolution of DKA. In low-resource settings where VBG is unavailable, electrolyte parameters alone may be used to determine DKA resolution.
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Affiliation(s)
- Julia E von Oettingen
- Division of Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC H4A3J1, Canada; Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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97
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Townson J, Gallagher D, Cowley L, Channon S, Robling M, Williams D, Hughes C, Murphy S, Lowes L, Gregory JW. "Keeping it on your radar"-assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: A qualitative study from the early detection of type 1 diabetes in youth study. Endocrinol Diabetes Metab 2018; 1:e00008. [PMID: 30815545 PMCID: PMC6373827 DOI: 10.1002/edm2.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/29/2017] [Accepted: 11/12/2017] [Indexed: 01/25/2023] Open
Abstract
AIMS The aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood. METHODS Qualitative interviews and free-text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses. Data were analysed thematically and 30% double coded. RESULTS Two key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help. Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their "radar", to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it. CONCLUSIONS Knowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community-based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.
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Affiliation(s)
- Julia Townson
- Centre for Trial Research (CTR)Cardiff UniversityCardiffUK
| | | | - Laura Cowley
- Division of Population MedicineCardiff UniversityCardiffUK
| | - Susan Channon
- Centre for Trial Research (CTR)Cardiff UniversityCardiffUK
| | | | | | | | - Simon Murphy
- DECIPHerSchool of Social SciencesCardiff UniversityCardiffUK
| | - Lesley Lowes
- School of Healthcare SciencesCardiff UniversityCardiffUK
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98
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Townson J, Gregory JW, Cowley L, Gallagher D, Channon S, Robling M, Williams D, Hughes C, Murphy S, Lowes L. Establishing the feasibility of a community and primary health care intervention to raise awareness of symptoms of Type 1 Diabetes-The Early Detection of Type 1 Diabetes in Youth (EDDY) study. Pediatr Diabetes 2017; 18:955-963. [PMID: 28261940 DOI: 10.1111/pedi.12516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS To design, develop, and evaluate the feasibility of delivering a multi-component community based intervention to parents and primary health care professionals to raise awareness of the symptoms of Type 1 diabetes (T1D) in childhood in 3 adjoining borough counties of South Wales. MATERIALS AND METHODS Parent and primary health care advisory groups were established to design the intervention. Qualitative interviews with stakeholders and parents assessed the acceptability, feasibility and any potential impact of the intervention. RESULTS The parent component of the intervention developed was a re-useable shopping bag with the 4 main symptoms of T1D illustrated on the side, based on the road traffic system of red warning triangles and an octagon "stop" sign stating "Seek Medical Help". Accompanying the bag was an A5 leaflet giving further information. Both were overwrapped with clear plastic and delivered to 98% (323/329) schools, equating to 101 371 children. The primary health care professional component was a dual glucose/ketone meter, single use lancets, stickers, the A5 parent leaflet displayed as a poster and an educational visit from a Community Diabetes Liaison Nurse. 87% (73/84) of GP practices received the intervention, 100% received the materials. The intervention was delivered within Cardiff, the Vale of Glamorgan and Bridgend. Qualitative analyses suggest that the intervention raised awareness and had some impact. CONCLUSION This study showed that it is feasible and acceptable to design, develop and deliver a community based intervention to raise awareness of T1D. There is some suggestion of impact but a definitive evaluation of effectiveness is still required.
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Affiliation(s)
- J Townson
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - J W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - L Cowley
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - D Gallagher
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - S Channon
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | - M Robling
- Centre for Trial Research (CTR), Cardiff University, Cardiff, UK
| | | | - C Hughes
- Patient representative, Cardiff, UK
| | - S Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - L Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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99
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Steck AK, Larsson HE, Liu X, Veijola R, Toppari J, Hagopian WA, Haller MJ, Ahmed S, Akolkar B, Lernmark Å, Rewers MJ, Krischer JP. Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls. Pediatr Diabetes 2017; 18:794-802. [PMID: 28127835 PMCID: PMC5529265 DOI: 10.1111/pedi.12485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore whether children diagnosed with type 1 diabetes during islet autoantibody surveillance through The Environmental Determinants of Diabetes in the Young (TEDDY) study retain greater islet function than children diagnosed through the community. METHODS TEDDY children identified at birth with high-risk human leukocyte antigen and followed every 3 months until diabetes diagnosis were compared to age-matched children diagnosed with diabetes in the community. Both participated in long-term follow up after diagnosis. Hemoglobin A1c (HbA1c) and mixed meal tolerance test were performed within 1 month of diabetes onset, then at 3, 6, and 12 months, and biannually thereafter. RESULTS Comparison of 43 TEDDY and 43 paired control children showed that TEDDY children often had no symptoms (58%) at diagnosis and none had diabetic ketoacidosis (DKA) compared with 98% with diabetes symptoms and 14% DKA in the controls (P < 0.001 and P = 0.03, respectively). At diagnosis, mean HbA1c was lower in TEDDY (6.8%, 51 mmol/mol) than control (10.5%, 91 mmol/mol) children (P < 0.0001). TEDDY children had significantly higher area under the curve and peak C-peptide values than the community controls throughout the first year postdiagnosis. Total insulin dose and insulin dose-adjusted A1c were lower throughout the first year postdiagnosis for TEDDY compared with control children. CONCLUSIONS Higher C-peptide levels in TEDDY vs community-diagnosed children persist for at least 12 months following diabetes onset and appear to represent a shift in the disease process of about 6 months. Symptom-free diagnosis, reduction of DKA, and the potential for immune intervention with increased baseline C-peptide may portend additional long-term benefits of early diagnosis.
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Affiliation(s)
- Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Xiang Liu
- Health Informatics Institute, University of South Florida, Tampa, Florida
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jorma Toppari
- Turku Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - William A Hagopian
- Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, WA
| | - Michael J Haller
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Simi Ahmed
- Immunology of T1D, JDRF International, New York, New York
| | - Beena Akolkar
- Division of Diabetes, Endocrinology & Metabolism, National Institute of Diabetes, Digestive, & Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey P Krischer
- Health Informatics Institute, University of South Florida, Tampa, Florida
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100
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Szypowska A, Dżygało K, Wysocka-Mincewicz M, Mazur A, Lisowicz L, Ben-Skowronek I, Sieniawska J, Klonowska B, Charemska D, Nawrotek J, Jałowiec I, Bossowski A, Jamiołkowska M, Pyrżak B, Rogozińska I, Szalecki M. High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study. Pediatr Diabetes 2017; 18:722-728. [PMID: 27726262 DOI: 10.1111/pedi.12446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.
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Affiliation(s)
| | - Katarzyna Dżygało
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Lucyna Lisowicz
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Iwona Ben-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Joanna Sieniawska
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Bożenna Klonowska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Jolanta Nawrotek
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Irena Jałowiec
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Milena Jamiołkowska
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Pyrżak
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Rogozińska
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.,Faculty of Medicine and Health Sciences, UJK, Kielce, Poland
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