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Alhamdani YF, Almadfaa LO, AlAgha AE. Clinical variables influencing the severity of diabetes ketoacidosis. Saudi Med J 2024; 45:502-509. [PMID: 38734437 PMCID: PMC11147548 DOI: 10.15537/smj.2024.45.4.20240058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/06/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To evaluate clinical indicators in order to examine the intensity of diabetes ketoacidosis (DKA) episodes in children and adolescents diagnosed with type 1 diabetes mellitus (T1DM). METHODS Data from 156 T1DM patients aged 6 months to 14 years, who presented with DKA to the emergency room, were retrospectively reviewed from 2018 to 2022. Data on demographic characteristics, economic status, initial clinical presentation, glycemic control, DKA severity, and laboratory evaluations were also collected. RESULTS Diabetes ketoacidosis episodes were more prevalent among male patients during the middle childhood age group. Notably, these episodes displayed seasonal patterns. The severity was found to be inversely associated with economic status and positively correlated with early adolescence. Newly diagnosed T1DM patients constituted 52.9%, with a statistically significant connection observed between severe DKA and this subgroup. Furthermore, there was a significant escalation in poor glycemic control with episode severity. Prolonged episode duration also exhibited a statistically significant association with more severity. Gastrointestinal symptoms were commonly reported during the presentation. Moreover, several clinical signs and symptoms, including decreased consciousness, reduced activity, drowsiness, Kussmaul breathing, shortness of breath, vomiting, tachycardia, and severe dehydration, were significantly correlated with the severity of DKA (p<0.05). Hypernatremia was more frequent among children with severe DKA. CONCLUSION Diabetes ketoacidosis was observed to occur more frequently among males in middle childhood with seasonal variations. Furthermore, the severity of DKA was associated with lower economic status, early adolescence, and the presence of hypernatremia.
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Affiliation(s)
- Yara F. Alhamdani
- From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Lojain O. Almadfaa
- From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulmoein E. AlAgha
- From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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Huang A, Chen Q, Yang W, Cui Y, Wang Q, Wei H. Clinical characteristics of 683 children and adolescents, aged 0-18 years, newly diagnosed with type 1 diabetes mellitus in Henan Province: a single-center study. BMC Pediatr 2023; 23:39. [PMID: 36683033 PMCID: PMC9869500 DOI: 10.1186/s12887-023-03847-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a common chronic systemic disease that threatens the health of children worldwide. Diabetic ketoacidosis (DKA) is the most severe acute complication of diabetes and can lead to death. This study aimed to explore the epidemiological features, clinical manifestations, and risk factors for DKA in children and adolescents newly diagnosed with T1DM in the Department of Endocrinology of the Children's Hospital of Henan Province. METHODS Medical records of 683 children and adolescents newly diagnosed with T1DM in our center from March 2014 to November 2021 were retrospectively analyzed. The data included the general condition, laboratory indexes, and clinical symptoms. The patients were divided into three groups according to age: Group I, 0-3 years; Group II, 4-9 years; and Group III, 10-18 years. RESULTS The incidence of DKA was 62.96% and was highest in Group I. Group I had the lowest C-peptide and hemoglobin A1c, but the highest blood glucose at first diagnosis, and 25-hydroxyvitamin D3 levels, hospitalization lengths, and medical costs. 25.5% of the children were delayed in diagnosis. Logistic regression analysis showed that elevated HbA1c levels and hyperglycemia were independent risk factors for DKA. On the other hand, C-peptide and 25- hydroxyvitamin D were protective factors for DKA. CONCLUSIONS The incidence of DKA among children and adolescents in the Henan Province is very high. Moreover, DKA can be easily delayed in diagnosis. Newly diagnosed infants with T1DM are more likely to present with DKA, suffer more severe metabolic disorders, endure longer hospital stays, and accrue higher medical costs.
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Affiliation(s)
- Ai Huang
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Qiong Chen
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Wei Yang
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Yan Cui
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Qingzhi Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haiyan Wei
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China.
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Acute kidney injury and diabetic kidney disease in children with acute complications of diabetes. Pediatr Nephrol 2022; 38:1643-1652. [PMID: 36227434 PMCID: PMC10060302 DOI: 10.1007/s00467-022-05735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/12/2022] [Accepted: 09/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) and hyperglycaemia without ketoacidosis are common acute complications of diabetes. Their association with acute kidney injury (AKI) and diabetic kidney disease (DKD) was studied. METHODS The study group consisted of 197 children with type 1 diabetes with average diabetes duration of 8.08 ± 2.32 years. The medical history of the patients was retrospectively reviewed. The number of children with severe hyperglycaemia, DKA and AKI was assessed. The association with the risk of chronic kidney disease (CKD) was analysed. RESULTS AKI was found in 14% of cases hospitalised for DKA and 8% of cases hospitalised for hyperglycaemia. Patients with AKI showed a significantly increased corrected sodium (141.23 ± 5.09 mmol/L, p = 0.035). Patients with AKI in DKA showed a significant increase in WBC (20.73 ± 8.71 × 103/µL, p = 0.0009). Follow-up analysis after a minimum of 5 years of diabetes revealed that a single episode of DKA was found in 63 patients and a single episode of AKI in 18 patients. Two or more episodes of DKA were found in 18 patients, and nine cases were complicated by AKI. These patients showed a significant increase in urinary albumin excretion (44.20 ± 64.21 mg/24 h), the highest values of eGFR and the worst glycaemic control. CONCLUSIONS Diabetic children can develop AKI in the course of DKA and hyperglycaemia without ketoacidosis, which is associated with volume depletion and reflected by corrected sodium concentration. AKI in DKA seems to be complicated by stress and inflammation activation. AKI and poor glycaemic control with repeated DKA episodes can magnify the risk of progression to DKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Melena I, Piani F, Tommerdahl KL, Severn C, Chung LT, MacDonald A, Vinovskis C, Cherney D, Pyle L, Roncal-Jimenez CA, Lanaspa MA, Rewers A, van Raalte DH, Cara-Fuentes G, Parikh CR, Nelson RG, Pavkov ME, Nadeau KJ, Johnson RJ, Bjornstad P. Aminoaciduria and metabolic dysregulation during diabetic ketoacidosis: Results from the diabetic kidney alarm (DKA) study. J Diabetes Complications 2022; 36:108203. [PMID: 35523653 PMCID: PMC9119939 DOI: 10.1016/j.jdiacomp.2022.108203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/17/2022] [Accepted: 04/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We examined changes in the excretion of various amino acids and in glycolysis and ketogenesis-related metabolites, during and after diabetic ketoacidosis (DKA) diagnosis, in youth with known or new onset type 1 diabetes (T1D). METHODS Urine samples were collected from 40 youth with DKA (52% boys, mean age 11 ± 4 years, venous pH 7.2 ± 0.1, blood glucose 451 ± 163 mg/dL) at 3 time points: 0-8 h and 12-24 h after starting an insulin infusion, and 3 months after hospital discharge. Mixed-effects models evaluated the changes in amino acids and other metabolites in the urine. RESULTS Concentrations of urine histidine, threonine, tryptophan, and leucine per creatinine were highest at 0-8 h (148.8 ± 23.5, 59.5 ± 12.3, 15.4 ± 1.4, and 24.5 ± 2.4% of urine creatinine, respectively), and significantly decreased over 3 months (p = 0.028, p = 0.027, p = 0.019, and p < 0.0001, respectively). Urine histidine, threonine, tryptophan, and leucine per urine creatinine decreased by 10.6 ± 19.2, 0.7 ± 0.9, 1.3 ± 0.9, and 0.5 ± 0.3-fold, respectively, between 0 and 8 h and 3 months. CONCLUSIONS In our study, DKA was associated with profound aminoaciduria, suggestive of proximal tubular dysfunction analogous to Fanconi syndrome.
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Affiliation(s)
- Isabella Melena
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Federica Piani
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kalie L Tommerdahl
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cameron Severn
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, CO, USA
| | - Linh T Chung
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexis MacDonald
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carissa Vinovskis
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Cherney
- Department of Medicine, Division of Nephrology, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Laura Pyle
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, CO, USA
| | - Carlos A Roncal-Jimenez
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miguel A Lanaspa
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Arleta Rewers
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniël H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Gabriel Cara-Fuentes
- Department of Pediatrics, Section of Nephrology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chirag R Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert G Nelson
- Chronic Kidney Disease Section, Phoenix Epidemiology and Clinical Research Branch, NIDDK, Phoenix, AZ, USA
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard J Johnson
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Petter Bjornstad
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA.
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The relationship between hyperchloremia and acute kidney injury in pediatric diabetic ketoacidosis and its impact on clinical outcomes. Pediatr Nephrol 2022; 37:1407-1413. [PMID: 34738144 DOI: 10.1007/s00467-021-05279-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketogenesis, and increased anion gap metabolic acidosis. Such derangements are accompanied by volume depletion as well as electrolyte disturbances. Resuscitation using traditional saline in DKA patients can exacerbate electrolyte abnormalities, in particular the production of hyperchloremia. Severe hypovolemia can result in acute kidney injury (AKI). The link between hyperchloremia and AKI is controversial. This study aimed to assess the relationship between hyperchloremia and AKI in pediatric patients with DKA and its impacts on clinical outcomes. METHODS This cross-sectional study was conducted on 70 children with DKA admitted to the pediatric intensive care unit in which all patients were subjected to detailed medical history taking and full clinical examination. Daily assessment of Na, K, urea, creatinine, chloride, arterial blood gases, and albumin/creatinine ratio (ACR) was done. AKI was defined as pRIFLE stage I and F. RESULTS Hyperchloremia was detected in 65.7% of patients at admission and in 52.9% after 24 h (p = 0.17). AKI was documented in 28% of patients. At admission hyperchloremia was detected in 56% of patients without AKI versus 90% of patients with AKI (p = 0.007). After 24 h, hyperchloremia was detected in 48.4% patients without versus 100% of patients with AKI. Chloride was significantly positively correlated to duration of admission, creatinine, ACR, and negatively correlated to eGFR. CONCLUSION The development of AKI in patients with DKA was accompanied by hyperchloremia, increased time to DKA resolution, and longer hospital stay. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Batwa M, Alharthi L, Ghazal R, Alsulami M, Slaghour R, Aljuhani R, Bakhsh A. Diabetic Ketoacidosis at the Onset of Type 1 Diabetes Mellitus Among Children and Adolescents in Jeddah, Saudi Arabia: A Study From the Emergency Department. Cureus 2022; 14:e24456. [PMID: 35651441 PMCID: PMC9132753 DOI: 10.7759/cureus.24456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) and a leading cause of morbidity and mortality in children. We aim to assess the frequency, clinical characteristics, biochemical findings, and outcomes of DKA at the onset of T1DM in young children and adolescents. Design and methods: This retrospective cohort study analyzed the medical records of patients ≤ 16 years old seen in the emergency department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between April 2015 and June 2019. The severity of DKA was classified according to the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria. Results: Out of 207 patients with T1DM, 53 presented with DKA as a new onset. The mean age was 8.51 ± 3.81 years, with the majority being 5-10 years old (52.8%). Polyuria (98.1%), polydipsia (86.8%), weight loss (62.3%), and abdominal pain and vomiting (45.3%) were the most frequent symptoms. Mean random blood glucose was 424.09 ± 108.67 mg/dL and mean venous pH was 7.15 ± 0.36 mmol/L. Of patients, 66% had no associated complications, 24.4% had hypokalemia, 20.8% developed hypoglycemia, and 18.9% developed hyperchloremic metabolic acidosis. One patient had cerebral edema and coma. Based on metabolic acidosis, 24.5% had mild DKA, an equal percentage had severe DKA, and 9.4% had moderate DKA. Of patients, 88.7% were admitted to the pediatric ward and 15.1% to the intensive care unit. Conclusion: A total of 25% of patients diagnosed with T1DM below the age of 17 years presented with DKA. No permanent disabilities or deaths were reported. Forming a registry dedicated to T1DM is needed to follow up on these patients, especially among school-age children, as well as aid in the development of future research locally.
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Alblihed M. Primary understanding of type 1 diabetes as an autoimmune disease. SAUDI JOURNAL FOR HEALTH SCIENCES 2022. [DOI: 10.4103/sjhs.sjhs_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Piani F, Reinicke T, Borghi C, Tommerdahl KL, Cara-Fuentes G, Johnson RJ, Bjornstad P. Acute Kidney Injury in Pediatric Diabetic Kidney Disease. Front Pediatr 2021; 9:668033. [PMID: 34211943 PMCID: PMC8239177 DOI: 10.3389/fped.2021.668033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Diabetic kidney disease (DKD) is a common complication of type 1 and 2 diabetes and often presents during adolescence and young adulthood. Given the growing incidence of both type 1 and type 2 diabetes in children and adolescents, DKD represents a significant public health problem. Acute kidney injury (AKI) in youth with diabetes is strongly associated with risk of DKD development. This review will summarize the epidemiology and pathophysiology of AKI in children with diabetes, the relationship between AKI and DKD, and the potential therapeutic interventions. Finally, we will appraise the impact of the recent COVID-19 infection pandemic on AKI in children with diabetes.
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Affiliation(s)
- Federica Piani
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Medicine and Surgery Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Trenton Reinicke
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Claudio Borghi
- Department of Medicine and Surgery Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Kalie L Tommerdahl
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gabriel Cara-Fuentes
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Section of Pediatric Nephrology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, United States
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Petter Bjornstad
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Huang SK, Huang CY, Lin CH, Cheng BW, Chiang YT, Lee YC, Yeh SN, Chan CI, Chua WK, Lee YJ, Ting WH. Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis. PLoS One 2020; 15:e0239160. [PMID: 33027293 PMCID: PMC7540857 DOI: 10.1371/journal.pone.0239160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is associated with dehydration and which can cause acute kidney injury (AKI). The proportion of AKI in children and adolescents with DKA has not been reported in East Asian population. This study aimed to identify the prevalence of AKI and to determine whether there is an association between AKI severity and recovery time from metabolic acidosis in children and adolescents with DKA. Medical records of children and adolescents (aged <18 years) presenting with type 1 or type 2 diabetes mellitus and DKA between 2000–2017 at the MacKay Children’s Hospital were retrospectively reviewed. AKI was defined by an admission creatinine level >1.5 times the calculated expected baseline creatinine level. Patients were divided into three groups based on AKI severity: no AKI, mild AKI, and severe AKI. In total, 170 (56.5%) patients with DKA presented AKI (mild AKI, 116 [38.5%]; severe AKI, 54 [18.0%]). Heart rate and laboratory parameters related to dehydration, such as corrected sodium level and blood urea nitrogen, were strongly associated with AKI development (P<0.01). Blood pH, plasma glucose, and potassium levels were also associated with AKI. A negative correlation with borderline significance between the estimated glomerular filtration rate (eGFR) and recovery time from metabolic acidosis was observed in the severe AKI group. AKI was highly prevalent in children and adolescents with DKA. An association between AKI and biomarkers indicating dehydration was noted. The recovery time from metabolic acidosis following treatment may be longer in children with a decreased eGFR who present with severe AKI. AKI is a common complication in children with DKA.
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Affiliation(s)
- Shih-Kang Huang
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chi-Yu Huang
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
| | - Bi-Wen Cheng
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Ya-Ting Chiang
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatric Endocrinology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yi-Chen Lee
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
| | - Shu-Nin Yeh
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Saint Paul’s Hospital, Taoyuan, Taiwan
| | - Chon-In Chan
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Centro Hospitalar Conde de São Januário, Macau, Taiwan
| | - Wei-Kian Chua
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Medical Research, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Wei-Hsin Ting
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
- * E-mail:
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Fawwad A, Waris N, Askari S, Ogle G, Ahmedani MY, Basit A. Relationship of C-peptide levels to duration of Type 1 diabetes - A study from Sindh, Pakistan. Pak J Med Sci 2020; 36:765-769. [PMID: 32494271 PMCID: PMC7260921 DOI: 10.12669/pjms.36.4.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the relationship of C-peptide levels with duration of type 1 diabetes mellitus. METHODS This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from December 2013 to December 2015. A total of 184 subjects were recruited during the study period, 100 in Group-A and 84 in Group-B. Subjects clinically diagnosed with type 1 diabetes Mellitus (T1DM) were categorized into two groups based on duration of diabetes: Group-A (with ≤1-year duration of diabetes) and Group-B (with >1-year duration of diabetes). Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study. Blood samples were drawn for biochemical parameters. Data for baseline characteristics and clinical parameters (HbA1c and C-peptide) were obtained from hospital management system of BIDE. RESULTS Fifty-seven (57.6%) subjects in Group-A, and 39 (46.4%) in Group-B were males. Mean±SD duration of diabetes (years) was 0.64±0.6 (range 0-1) in Group-A, and 7.65±5.5 (range 1-23) in Group-B. Family history of T1DM and T2DM was 1(1%) and 27(27.3%) in Group-A, and 8(9.52%) and 21(25%) in Group-B, respectively. Twenty-one (21.2%) subjects presented in diabetic ketoacidosis (DKA) in Group-A and 18(21.4%), in Group-B. Mean±SD for HbA1c was non-significantly higher in Group-A 11.12±2.31 compared to Group-B 10.42±1.45. Mean±SD for C-peptide was 1.91±1.53 ng/mL (0.60±0.481 nmol/L) in Group-A, and 1.82±1.01 (0.57±0.32 nmol/L) in Group-B (p=0.984). CONCLUSION The study found that subjects with longer duration of T1DM had non-significantly decreased C-peptide levels compared to a group in which C-peptide was measured at or soon after diagnosis. Furthermore, C-peptide levels in many subjects with longer duration were higher than expected in classic T1DM.
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Affiliation(s)
- Asher Fawwad
- Asher Fawwad, PhD. Professor & Head of the Biochemistry Department (BMU), Honorary Research Director (BIDE), Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Baqai Medical University (BMU), Karachi, Pakistan
| | - Nazish Waris
- Nazish Waris, M.Phil. Clinical Biochemistry and Psychopharmacology Research Unit Department of Biochemistry, University of Karachi-Pakistan Research Associate, Research Department (BIDE-BMU), Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Baqai Medical University (BMU), Karachi, Pakistan
| | - Saima Askari
- Saima Askari, Fellow Endocrine, (BIDE-BMU), Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Baqai Medical University (BMU), Karachi, Pakistan
| | - Graham Ogle
- Graham David Ogle, General Manager, Life for a Child Program, Diabetes NSW, Glebe, NSW, Sydney, Australia
| | - Muhammad Yakoob Ahmedani
- Muhammad Yakoob Ahmedani, FCPS, Professor of Medicine, Department of Medicine (BIDE-BMU), Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Baqai Medical University (BMU), Karachi, Pakistan
| | - Abdul Basit
- Abdul Basit, FRCP, Professor of Medicine (BMU), Director (BIDE), Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Baqai Medical University (BMU), Karachi, Pakistan
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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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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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Glackin S, Metzger D, Hanas R, Chanoine JP. Is Age a Risk Factor for Cerebral Edema in Children With Diabetic Ketoacidosis? A Literature Review. Can J Diabetes 2019; 44:111-118. [PMID: 31311730 DOI: 10.1016/j.jcjd.2019.04.013] [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: 08/24/2018] [Revised: 03/25/2019] [Accepted: 04/30/2019] [Indexed: 12/16/2022]
Abstract
Cerebral edema (CE) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA) in children with type 1 diabetes. CE is frequently mentioned as being more common in young children. The primary objective of this study was to review the evidence suggesting that younger age is a risk factor for the development of CE during DKA. The secondary objective was to assess if younger children are at a higher risk of DKA and severe DKA. A literature review was performed, and studies which reported the frequency of CE, DKA and severe DKA in children <3 and 3 to 5 years of age were included. Among the 6 studies reporting the frequency of CE that were identified, 5 good-quality studies found no significant association between younger age and higher risk of CE. Twenty-seven studies (DKA frequency: 11.3% to 54%) reported DKA frequency as a function of age. Most published studies found a higher frequency of DKA in children <5 years of age (20/25 studies), and in particular in those in the first 2 to 3 years of life (8/8 studies). There was inconclusive evidence to determine whether the severity of DKA was influenced by age. In conclusion, the commonly held view that CE is more common in younger children is not supported by the existing literature. Published data suggest that DKA (and possibly severe DKA) is more common in very young children. Regardless of age, all children with DKA should be monitored carefully for the development of CE.
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Affiliation(s)
- Sinead Glackin
- Endocrinology & Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Daniel Metzger
- Endocrinology & Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jean-Pierre Chanoine
- Endocrinology & Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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14
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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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15
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Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.7649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Atkilt HS, Turago MG, Tegegne BS. Clinical Characteristics of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in Addis Ababa, Ethiopia: A Cross-Sectional Study. PLoS One 2017; 12:e0169666. [PMID: 28135278 PMCID: PMC5279745 DOI: 10.1371/journal.pone.0169666] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022] Open
Abstract
Background Diabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa. Methods A hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included. DKA was defined as children below the age of 12 years who have blood glucose level ≥250mg/dl, ketonuria, and ketonemia and diagnosed being T1D patient for the first time. Descriptive statistics was performed using frequency distribution, mean, median, tables, and graphs. Logistic regression analysis was used to identify independent factors associated with the prevalence of DKA in children with newly diagnosed T1D. Results Of 395 DKA patients who were hospitalized during the five-year period, 142(35.8%) presented with DKA at first diagnosis of diabetes. On the other hand 253 (64.2%) children with DKA had longstanding T1D. Independent factors associated with DKA include: Age category 2–4.49years, 7–9.49 years and ≥9.5years (Adjusted odd ratio (AOR) = 3.14[1.21,8.06]), 3.44(1.39,8.49) and 4.02(1.68,9.60), respectively); parents’ knowledge on the sign and symptoms of DKA (AOR = 0.51[0.27, 0.95]); sign and symptoms of DKA before the onset of DKA (AOR = 0.35[0.21, 0.59]) and infection prior to DKA onset (AOR = 3.45[1.97, 6.04]). Conclusions The overall proportion of children diagnosed with DKA and new onset of T1D in Addis Ababa was high. In particular, children between 9–12 years of age and children whose parents did not know the sign and symptoms of DKA had a high risk of DKA at primary diagnosis of T1D.
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Affiliation(s)
| | - Muluken Gizaw Turago
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Balewgizie Sileshi Tegegne
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013; 12:47. [PMID: 24355514 PMCID: PMC7963434 DOI: 10.1186/2251-6581-12-47] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/06/2013] [Indexed: 02/08/2023]
Abstract
Background Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes mellitus (T1DM). Although the frequency of DKA as first manifestation of T1DM is higher in developing compared developed countries, there is paucity of information on its characteristics in developing countries. Methods This retrospective study determined the frequency of ketoacidosis at diagnosis of new-onset type 1 diabetes and described the clinical characteristics of the patients seen between 1996 and 2011 by auditing the hospital records of all cases. The diagnosis of diabetic ketoacidosis (DKA) was based on the presence of hyperglycaemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L) and ketonuria (urine ketone ≥1+). Results At diagnosis of new-onset type 1 diabetes mellitus, three-quarter (77.1%) of the children and adolescents presented with DKA. Comparing the frequency of DKA during the initial 8 years (1996–2003) with the later 8 years (2004–2011), it was 81.8% vs 73.1%; p > 005. The frequency has not shown any significant declined over a 16-year period. The frequency of re-admission in ketoacidosis was 24.3%. Conclusion Three-quarter of children and adolescents present with DKA as first manifestation of T1DM with no significant decline in frequency over a 16-year period in our hospital. Electronic supplementary material The online version of this article (doi:10.1186/2251-6581-12-47) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alphonsus N Onyiriuka
- Department of Child Health, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria.
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Elmehdawi RR, Ehmida M, Elmagrehi H, Alaysh A. Incidence and mortality of diabetic ketoacidosis in benghazi-libya in 2007. Oman Med J 2013; 28:178-83. [PMID: 23772283 DOI: 10.5001/omj.2013.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/20/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to estimate the incidence of diabetic ketoacidosis and the mortality rate at Benghazi city. METHODS A cross-sectional study of the records of all patients admitted with diabetic ketoacidosis to all Benghazi hospitals (governmental and private) between 1st of January and 31st of December 2007. RESULTS The annual incidence of diabetic ketoacidosis was 41.7 episodes/100,000 populations with a mean age of 33±20.1 years (2-93). Around 52% of all the episodes occurred in males and 2.6% of adult Diabetic ketoacidosis occurred in pregnant females. Type-2 diabetics were responsible for 27.7% of all episodes. The commonest precipitating factor in the whole study group was dose disruption (35%), followed by infection (20%). The most common presenting symptoms were gastrointestinal, whilst 3.5% of the patients were comatose at presentation. The overall mortality was 11.7% and there was no significant difference in mortality between males and females (11% vs. 12.6%; p=0.6); however, type-2 diabetics showed a significantly higher mortality rate (29.3% vs. 4.9%; p=0.000). CONCLUSION Diabetic ketoacidosis is a common condition in Libya with a high mortality rate and type-2 diabetics constitute a considerable number of the cases.
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Affiliation(s)
- Rafik R Elmehdawi
- Assistant Professor, Medical Department, Faculty of Medicine-Benghazi University, Libya
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