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Shebani MS, Khashebi RM. Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011-2018) at a tertiary paediatric hospital in Tripoli, Libya. J Pediatr Endocrinol Metab 2024; 37:497-504. [PMID: 38695494 DOI: 10.1515/jpem-2024-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/29/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) stands as a critical, acute complication of type 1 diabetes. Despite its severity, there exists a dearth of data concerning the frequency and prevalence of DKA at the onset of type 1 diabetes in Libyan children. This study aimed to ascertain the frequency of DKA during the initial presentation of type 1 diabetes among children aged 0.5-14 years admitted to Tripoli Children's Hospital between 2011 and 2018. METHODS Employing a retrospective approach, the study examined the proportion of children with newly diagnosed type 1 diabetes who presented with DKA. Data analysis included estimating DKA frequency concerning age at presentation, sex, and age groups. The comparative analysis involved assessing DKA frequency between 0.5 and <2 and 2-14 years age groups. Logistic regression analysis evaluated the impact of age group, sex, and family history of type 1 diabetes on DKA and severe DKA occurrence. RESULTS Among 497 children with newly diagnosed type 1 diabetes, 39.2 % presented with DKA, of these 44.5 % had severe DKA. Females exhibited a higher DKA rate than males (OR 1.63, 95 % CI 1.13-2.34, p=0.009). Very young children (0.5 to <2 years) presented with DKA more frequently than those aged 2-14 years (OR 4.73, 95 % CI 2.65-8.47, p<0.001), and they were more likely to present in severe DKA (63.9 vs. 39.1 %, [OR 7.26, 95 % CI 3.65-14.41, p<0.001]). CONCLUSIONS The frequency of DKA at type 1 diabetes onset among children admitted to Tripoli Children's Hospital is notably high, with nearly half of the DKA episodes categorized as severe. Very young children notably demonstrated a fivefold increase in the likelihood of presenting with DKA.
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Affiliation(s)
- Mostafa Sasi Shebani
- Paediatric Endocrinology and Diabetes Department, 612518 Tripoli Children's Hospital , Tripoli, Libya
- Paediatric Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Rowida Mohammed Khashebi
- Paediatric Endocrinology and Diabetes Department, 612518 Tripoli Children's Hospital , Tripoli, Libya
- Paediatric Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Ditkovskaya LV, Aleksandrovich YS, Pshenisnov KV, Demchuk YA, Fel’ker EY. Severe course of diabetic ketoacidosis due to new coronavirus infection in older children (clinical cases). JOURNAL INFECTOLOGY 2023. [DOI: 10.22625/2072-6732-2022-14-5-101-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The risk of severe type I diabetes mellitus in children with new coronavirus infection (COVID-19) is extremely high, which is associated with a high risk of intracranial hypertension, cerebral edema and multiple organ dysfunction syndrome. On the example of a clinical case, the features of the course of diabetic ketoacidosis and intensive care measures in children with COVID-19 were considered. The main data of the history and clinical and laboratory examination are reflected, special attention is paid to the applied aspects of therapy, it was noted that with a severe course of a new coronavirus infection and diabetic ketoacidosis, the risk of developing cerebral injury, acute kidney injury and thromboembolic complications is quite high, which may require artificial lung ventilation for the purpose of cerebral protection, renal replacement therapy and the use of anticoagulants. The new coronavirus infection is a risk factor for the severe course of diabetic ketoacidosis in children with type I diabetes, regardless of the age of the child, which is the basis for clinical alertness in order to timely identify and treat potential life-threatening complications.
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Yen CW, Yu MC, Lee J. Serum electrolyte abnormalities in pediatric patients presenting to an emergency department with various diseases: Age-related differences. Pediatr Neonatol 2022; 63:575-581. [PMID: 35987755 DOI: 10.1016/j.pedneo.2022.04.008] [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: 01/05/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study evaluated the prevalence and frequency of serum electrolyte abnormalities (SEAs) in children presenting to a pediatric emergency department (PED) with various diseases. METHODS Pediatric patients (≤18 years) with blood electrolyte panels obtained in the PED of Lin-Kou Chang Gung Memorial Hospital, Taiwan, in the 5 years from January 1, 2016, to August 31, 2021, were enrolled in this retrospective observational study. Patients were divided into three age groups: Group A, < 4 years; Group B, 4-11 years; and Group C, 12-18 years. The associations between SEAs and clinical diseases in children and age-related differences were assessed. RESULTS This study included 182,058 pediatric patients visiting our PED over a 5-year period. A total of 250 (0.14%) patients with SEAs were included in the analysis. The study population consisted of 127 boys and 123 girls with a median (IQR) age of 9.0 (3.2-14.1) years. Hospital admission was required in 86.4% (n = 216) of the patients, and 32.4% (n = 81) of them were admitted to the pediatric intensive care unit (PICU). The median (IQR) hospital stay and PICU stay was 6.5 (4.0-11.0) and 4.0 (3.0-8.0) days, respectively. The PICU stay was longer in Group A (p < 0.05) and shorter in group C (p < 0.05). Hyponatremia was the most common SEA in group A (46.3%, n = 31), while hypokalemia was common in groups B (54.2%, n = 52) and C (32.2%, n = 28). Gastrointestinal, renal, and endocrine diseases were common clinical conditions associated with SEAs in pediatric patients in our PED. CONCLUSION The detection rate of SEAs in patients in the PED was 0.14%. Hyponatremia was a common SEA in pediatric patients aged <4 years, while the most common electrolyte disorder in those >4 years old was hypokalemia. In infants and young children, SEAs were associated with a longer PICU stay.
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Affiliation(s)
- Chen-Wei Yen
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Ching Yu
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Bali IA, Al-Jelaify MR, AlRuthia Y, Mulla JZ, Amlih DF, Bin Omair AI, Al Khalifah RA. Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children. JAMA Netw Open 2022; 5:e2230043. [PMID: 36066894 PMCID: PMC9449786 DOI: 10.1001/jamanetworkopen.2022.30043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE To compare the cost-effectiveness of mild uncomplicated DKA management with SC insulin aspart vs IV insulin infusion among pediatric patients from the perspective of a public health care payer using clinical data. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation included children aged 2 to 14 years presenting to the emergency department of a single academic medical center with mild DKA between January 1, 2015, and March 15, 2020. The medical records for DKA treatment course and its associated hospitalization costs were reviewed. Data were analyzed from January 1, 2015, to March 15, 2020. EXPOSURES Subcutaneous insulin aspart vs IV regular insulin infusion. MAIN OUTCOMES AND MEASURES The incremental cost-effectiveness ratio (US dollars per hour), duration of DKA treatment, and length of hospital stay. RESULTS A total of 129 children with mild DKA episodes (mean [SD] age, 9.9 [3.1] years; 72 girls [55.8%]) were enrolled in the study. Seventy children received SC insulin aspart and 59 received IV regular insulin. Overall, the length of hospital stay in the SC insulin group was reduced (mean, 16.9 [95% CI, -31.0 to -2.9] hours) compared with the IV insulin group (P = .005). The mean (SD) cost of hospitalization in the SC insulin group (US $1071.99 [US $523.89]) was less than that in the IV insulin group (US $1648.90 [US $788.03]; P = .001). The incremental cost-effectiveness ratio was -34.08 (95% CI, -25.97 to -129.82) USD/h. The use of SC insulin aspart was associated with a lower likelihood of prolonged hospital stay (β = -17.22 [95% CI, -32.41 to -2.04]; P = .03) than IV regular insulin when controlling for age and sex. CONCLUSION AND RELEVANCE Findings of this economic evaluation suggest that SC insulin aspart is dominant vs IV regular insulin in the management of mild uncomplicated DKA in children.
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Affiliation(s)
- Ibrahim Abdulaziz Bali
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jaazeel Zohair Mulla
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dana Fawzi Amlih
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Reem Abdullah Al Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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5
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Koripalli M, Giruparajah M, Laur C, Shulman R. Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework. Pediatr Diabetes 2022; 23:406-410. [PMID: 35001490 DOI: 10.1111/pedi.13314] [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: 11/09/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The rate of diabetic ketoacidosis (DKA), a preventable, life-threatening complication of diabetes, at the time of diagnosis in children remains unacceptably high worldwide. We describe our initial approach to selecting a national DKA prevention strategy, to be implemented by the Canadian Pediatric Endocrine Group DKA Prevention Working Group, informed by a framework for behavior change interventions. METHODS Existing interventions were identified from a systematic review and our own gray literature search. We then characterized interventions using the Behavior Change Wheel, a framework to inform and drive behavior change, and matched interventions to behavioral targets, audiences, and identified barriers and facilitators. Feedback from the CPEG DKA prevention working group was incorporated into the intervention plan. RESULTS We identified 27 interventions. Our proposed target behaviors are: (1) prompt recognition of symptoms of diabetes in children; (2) urgent attendance to medical care with a request for an office-based test for diabetes; and (3) rapid confirmation of diagnosis and urgent consultation with pediatric diabetes experts. We initially identified four possible intervention functions including education, training, environment restructuring, and enablement. Feedback from the working group favored education intervention functions including symptom recognition messages targeting parents, caregivers, teachers, and providers and messages about how to make a rapid diagnosis and need for urgent referral targeting providers. CONCLUSIONS The Behavior Change Wheel has been used successfully in selecting interventions in other clinical areas. We describe how we used this framework to provide a foundation for developing an intervention to prevent DKA at diabetes diagnosis in children.
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Affiliation(s)
- Maanasa Koripalli
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada
| | - Mohana Giruparajah
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada
| | - Celia Laur
- Women's College Hospital, Institute for Health System Solutions and Virtual Care (WIHV), Toronto, Ontario, Canada
| | - Rayzel Shulman
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Jensen ET, Stafford JM, Saydah S, D'Agostino RB, Dolan LM, Lawrence JM, Marcovina S, Mayer-Davis EJ, Pihoker C, Rewers A, Dabelea D. Increase in Prevalence of Diabetic Ketoacidosis at Diagnosis Among Youth With Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021; 44:1573-1578. [PMID: 34099516 PMCID: PMC8323183 DOI: 10.2337/dc20-0389] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We previously reported a high (˜30%) but stable prevalence of diabetic ketoacidosis (DKA) at youth-onset diagnosis of type 1 diabetes (2002 and 2010). Given the changing demographics of youth-onset type 1 diabetes, we sought to evaluate temporal trends in the prevalence of DKA at diagnosis of type 1 diabetes from 2010 to 2016 among youth <20 years of age and evaluate whether any change observed was associated with changes in sociodemographic distribution of those recently diagnosed. RESEARCH DESIGN AND METHODS We calculated prevalence of DKA within 1 month of type 1 diabetes diagnosis by year and evaluated trends over time (2010-2016) (n = 7,612 incident diabetes cases; mean [SD] age 10.1 [4.5] at diagnosis). To assess whether trends observed were attributable to the changing distribution of sociodemographic factors among youth with incident type 1 diabetes, we estimated an adjusted relative risk (RR) of DKA in relation to calendar year, adjusting for age, sex, race/ethnicity, income, education, health insurance status, language, season of diagnosis, and SEARCH for Diabetes in Youth Study site. RESULTS DKA prevalence increased from 35.3% (95% CI 32.2, 38.4) in 2010 to 40.6% (95% CI 37.8, 43.4) in 2016 (P trend = 0.01). Adjustment for sociodemographic factors did not substantively change the observed trends. We observed a 2% annual increase in prevalence of DKA at or near diagnosis of type 1 diabetes (crude RR 1.02 [95% CI 1.01, 1.04] and adjusted RR 1.02 [95% CI 1.01, 1.04]; P = 0.01 for both). CONCLUSIONS Prevalence of DKA at or near type 1 diabetes diagnosis has increased from 2010 to 2016, following the high but stable prevalence observed from 2002 to 2010. This increase does not seem to be attributable to the changes in distribution of sociodemographic factors over time.
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Affiliation(s)
- Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lawrence M Dolan
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Santica Marcovina
- Northwest Lipid Research Laboratories, University of Washington, Seattle, WA
| | | | | | - Arleta Rewers
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
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7
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Ho J, Rosolowsky E, Pacaud D, Huang C, Lemay J, Brockman N, Rath M, Doulla M. Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic. Pediatr Diabetes 2021; 22:552-557. [PMID: 33745226 PMCID: PMC8251027 DOI: 10.1111/pedi.13205] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 03/06/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID-19 public health measures were enacted. RESEARCH DESIGN AND METHODS A retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Rates of DKA and severe DKA were compared to the same time period in the year 2019 (pre-pandemic control). RESULTS The number of children presenting with newly diagnosed DM1 was similar during the pandemic year of 2020 compared with 2019 (107 children in 2020 vs. 114 in 2019). The frequency of DKA at DM1 onset was significantly higher in the pandemic period (68.2% vs 45.6%; p < 0.001) and incidence of severe DKA was also higher (27.1% in 2020 vs 13.2% in 2019; p = 0.01). CONCLUSIONS There was a significant increase in DKA and severe DKA in children presenting with new onset DM1 during the COVID-19 pandemic period. This emphasizes the need for educating health care professionals and families to be aware of the symptoms of hyperglycemia and the importance of early diagnosis and treatment even during public health measures for COVID-19.
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Affiliation(s)
- Josephine Ho
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carol Huang
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | | | | | - Manpreet Doulla
- Division of Pediatric Endocrinology, Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
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Darmonkow G, Chafe R, Aslanova R, Hagerty D, Twells L, Barter OJ, Allwood Newhook LA. A Multi-Intervention Campaign Lowers Pediatric and Young Adult Diabetic Ketoacidosis Hospitalizations in a Canadian Province. Can J Diabetes 2021; 45:792-797. [PMID: 34016537 DOI: 10.1016/j.jcjd.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The Newfoundland and Labrador diabetic ketoacidosis Project (NLdkaP) is a multi-intervention, province-wide project aimed at lowering rates of diabetic ketoacidosis (DKA) within the pediatric and young adult populations. METHODS The NLdkaP interventions were first selected, developed and implemented. We then conducted a retrospective study of hospitalization data over three 2-year periods: pre-, during and post-NLdkaP. Data included demographic factors, DKA hospitalizations and length of hospital stay. RESULTS There were 412 DKA hospitalizations over the study period. Before the NLdkaP, the provincial hospitalization rate of DKA for patients <25 years of age was 55.61 per 100,000. During the NLdkaP, the rate dropped to 38.48 per 100,000 (p<0.001). After the NLdkaP, the rate rose to 54.53 per 100,000 (p<0.001). Hospitalization rates were highest for females (p<0.001) and for those in the 19- to 24-year age group (p<0.001). CONCLUSIONS The NLdkaP was associated with decreased rates of DKA hospitalizations, but the rates remained relatively stable in both the pre- and postintervention periods. Although the approach and resources developed in the NLdkaP appear effective, continuous preventive efforts are needed to sustain reductions in DKA hospitalizations.
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Affiliation(s)
- Georgia Darmonkow
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; Janeway Pediatric Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Rana Aslanova
- Janeway Pediatric Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Donna Hagerty
- Janeway Pediatric Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Laurie Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Ola Jill Barter
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; Division of Children and Women's Health, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Leigh Anne Allwood Newhook
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; Janeway Pediatric Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; Division of Children and Women's Health, Eastern Health, St. John's, Newfoundland and Labrador, Canada.
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Sellers EAC, Pacaud D. Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic. Paediatr Child Health 2021; 26:208-209. [PMID: 34127934 PMCID: PMC8083512 DOI: 10.1093/pch/pxab017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Type 1 diabetes is a common chronic illness in childhood. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes. Early recognition of symptoms of diabetes and immediate initiation of treatment are important factors in preventing DKA at first presentation. We describe the numbers of children presenting with DKA at initial diagnosis across eight Canadian paediatric centres during the COVID-19 pandemic (March 15, 2020 to July 31, 2020) and compare this to the same time period in 2019. Comparing the pre-COVID to the COVID-19 time period, presentation in DKA increased from 36.4% to 55.0% (P<0.0001) and presentation in severe DKA from 37.0% to 48.3% (P=0.044). These findings are concerning and emphasize the importance of awareness of the signs and symptoms of diabetes. In addition, these findings raise concern about access to appropriate and timely care during the COVID-19 pandemic.
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Affiliation(s)
- Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Danièle Pacaud
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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McGregor S, Metzger DL, Amed S, Goldman RD. Fluid management in children with diabetic ketoacidosis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:817-819. [PMID: 33208421 PMCID: PMC8302425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
QUESTION Previous research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration? ANSWER Recent research has shown that neither fluid infusion rate nor sodium chloride concentration increases risk of cerebral injury. However, it is possible for subtle brain injury to occur during treatment, regardless of the fluid administration strategy. The 2018 International Society for Pediatric and Adolescent Diabetes guidelines have been updated in light of this research.
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Eledrisi MS, Elzouki AN. Management of Diabetic Ketoacidosis in Adults: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:165-173. [PMID: 32952507 PMCID: PMC7485658 DOI: 10.4103/sjmms.sjmms_478_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/20/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus. DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.
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Affiliation(s)
- Mohsen S Eledrisi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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12
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Kao KT, Islam N, Fox DA, Amed S. Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada. J Pediatr 2020; 221:165-173.e2. [PMID: 32446476 DOI: 10.1016/j.jpeds.2020.02.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To estimate the 11-year incidence trend of diabetic ketoacidosis (DKA) at and after the diagnosis of type 1 diabetes. STUDY DESIGN A retrospective cohort study using a population-based administrative cohort diagnosed with type 1 diabetes at <20 years of age from 2002 to 2012 in British Columbia, Canada. DKA at (1 episode per individual) and DKA after (multiple episodes per individual) the diagnosis of diabetes were defined as DKA occurring ≤14 days or >14 days, respectively, from diagnosis, identified using International Classification of Diseases,9th and 10theditions codes. Incidence rate ratios were estimated using Poisson regression and DKA trends using Joinpoint regression analyses. RESULTS There were 1519 individuals (mean age at first-DKA, 12.6 ± 5.9 years; 50% male) with ≥1 DKA episode identified. Of 2615 incident cases of type 1 diabetes, there were 847 (32.4%; mean age, 9.9 ± 4.8 years; 52% male) episodes of DKA at the diagnosis of diabetes. Among prevalent cases of type 1 diabetes (1790 cases in 2002 increasing to 2264 in 2012), there were 1886 episodes of DKA after the diagnosis of diabetes (mean age at first DKA, 15.7 ± 5.2 years). The rates per 100 person-years of DKA at diabetes diagnosis (ranging from 24.1 in 2008 to 37.3 in 2006) and DKA after diabetes diagnosis (ranging from 4.9 in 2002 to 7.7 in 2008) remained stable. Females showed a 67% higher rate of incidence of DKA after the diagnosis of diabetes compared with their male counterparts (incidence rate ratio, 1.67; 95% CI, 1.50-1.86; P < .001), adjusted for the temporal trend by fiscal year. Younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis and older children (≥10 years) had a greater risk of DKA after the diagnosis of diabetes. CONCLUSIONS The risk of DKA at the time of diagnosis of diabetes was greater with younger age and the risk of DKA after the diagnosis of diabetes was higher in females and older children and youth.
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Affiliation(s)
- Kung-Ting Kao
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Danya A Fox
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shazhan Amed
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Abstract
The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.
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Affiliation(s)
- Amy S Shah
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, 3333 Burnet Ave, ML 7012, Cincinnati, OH, 45229, USA.
| | - Kristen J Nadeau
- University of Denver, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Division of Endocrinology, Aurora, CO, USA
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14
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Robinson ME, Simard M, Larocque I, Shah J, Nakhla M, Rahme E. Risk of Psychiatric Disorders and Suicide Attempts in Emerging Adults With Diabetes. Diabetes Care 2020; 43:484-486. [PMID: 31843949 DOI: 10.2337/dc19-1487] [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] [Received: 07/26/2019] [Accepted: 11/15/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the longitudinal risks of psychiatric disorders in adolescents and emerging adults with versus without diabetes. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study in Quebec, Canada, using linked health administrative databases of adolescents (age 15 years) with and without diabetes and without prior psychiatric disorders between 1997 and 2015, followed to age 25 years. RESULTS Our cohort included 3,544 individuals with diabetes and 1,388,397 without diabetes. Individuals with diabetes were more likely to suffer from a mood disorder (diagnosed in the emergency department or hospital) (adjusted hazard ratio 1.33 [95% CI 1.19-1.50]), attempt suicide (3.25 [1.79-5.88]), visit a psychiatrist (1.82 [1.67-1.98]), and experience any type of psychiatric disorder (1.29 [1.21-1.37]) compared with their peers without diabetes. CONCLUSIONS Between the ages of 15 and 25 years, the risks of psychiatric disorders and suicide attempts were substantially higher in adolescents and emerging adults with versus without diabetes.
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Affiliation(s)
- Marie-Eve Robinson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Endocrinology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Simard
- Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Isabelle Larocque
- Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Jai Shah
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada .,Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
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