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Hirschler V, Gonzalez CD, Krochik G, Rousos AM, Andres ME, Riera F, Ibarcena PP, Molinari C, Porta LFP, Prieto M, Mateu CM, Barcala C, Arrigo MA, Tachetti J, Raggio M, Vacarezza V, Major ML, Sobrero AF, Bogado E, Lopez S, Povedano PP, Scaiola E, Leiva F, Pacheco G, Pasayo P, Dupuy M, Torossi MB, Benitez AJ, Marassi AE, Caballero Z, Garcia AL, Mazzetti S, Pugliese MIR, Gonzalez DS, Grabois F, Villar CMDA, Flores AB. Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children. J Pediatr Health Care 2024:S0891-5245(24)00023-3. [PMID: 38597850 DOI: 10.1016/j.pedhc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.
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Affiliation(s)
- Valeria Hirschler
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina.
| | - Claudio D Gonzalez
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina
| | - Gabriela Krochik
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Adriana M Rousos
- Head Physician Hospital de Niños Ricardo Gutierrez, Nutrition, Buenos Aires, Argentina
| | - Maria E Andres
- Head Physician Hospital de Niños Pedro de Elizalde, Nutrition, Buenos Aires, Argentina
| | - Francisca Riera
- Head Physician Pontificia Universidad Católica de Chile, Santiago, Chile, Pediatric Endocrinology, Santiago de Chile, Chile
| | - Paola Pinto Ibarcena
- Head Physician Endocrinology and Metabolism Service of the National Institute of Child Health, Lima, Peru
| | - Claudia Molinari
- Professor of the University of Buenos Aires, School of Pharmacy and Biochemistry, Mathematics, Buenos Aires, Argentina
| | | | - Mariana Prieto
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Consuelo Barcala
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Maria A Arrigo
- Head Physician HOSPITAL RAMON EXENI, San Justo, Argentina
| | - Jacqueline Tachetti
- Head Physician Hospital Italiano de San Justo Agustín Rocca, San JustoO, Argentina
| | - Marcela Raggio
- Head Physician Hospital Universitario Austral, Pilar, Argentina
| | | | - Maria L Major
- Head Physician Hospital Materno Infantil de San Isidro, San Isidro, Argentina
| | | | | | - Stella Lopez
- Head Physician Hospital Infantil Municipal, Cordoba, Argentina
| | - Paula Paz Povedano
- Head Physician Hospital de Niños de la Santísima Trinidad de Cordoba, Cordoba, Argentina
| | - Edit Scaiola
- Head Physician Private Clinic former Ushuaia, Ushuaia, Argentina
| | - Fabiana Leiva
- Head Physician Hospital Regional Rio Grande, Rio Grande, Argentina
| | - Gabriela Pacheco
- Head Physician Hospital Publico Materno Infantil De Salta, Pediatric Endocrinology, Salta, Argentina
| | - Patricia Pasayo
- Head Physician Hospital Materno Infantil Dr Hector Quintana, San Salvador De Jujuy, Argentina
| | - Mariana Dupuy
- Head Physician Hospital del niño Jesús - Tucumán, San Miguel De Tucuman, Argentina
| | - Maria B Torossi
- Head Physician Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, San Miguel de Tucuman, Argentina
| | - Amanda J Benitez
- Amanda J. Benitez-Hospital Pediatrico Juan Pablo Segundo, Corrientes, Argentina
| | | | - Zulema Caballero
- Head Physician Hospital Pediatrico Dr. Avelino Lorenzo Castelán, Resistencia, Argentina
| | - Ana L Garcia
- Head Physician Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - Sandra Mazzetti
- Head Physician Hospital de Niños Victor J Vilela, Rosario, Argentina
| | | | - Diana S Gonzalez
- Hospital Provincial Neuquen Dr. Castro Rendon, Neuquen, Argentina
| | | | | | - Adriana B Flores
- Head Physician Fundacion Hospitalaria Htal privado materno infanto juvenil, Buenos Aires, Argentina
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