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

Abstract

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

Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia

“…Similar results were presented in the studies conducted in two other centers in Croatia [ 25 ]. Compared to the results from centers in China and Turkey (33.9% and 15.9%, respectively) our results show a higher number of children with severe metabolic acidosis on admission [ 5 , 26 ]. We can speculate that in our region if T1D symptoms are not recognized early by caregivers, when only polyuria and polydipsia are present, they are recognized very late when severe metabolic acidosis has developed and the risk of severe DKA complications is much higher.…”

“…The percentage of DKA as the initial presentation of T1D varies significantly between institutions and countries. Recently published studies from centers in China, Australia, Saudi Arabia, and Serbia show large variations in the incidence of DKA as the initial presentation of T1D, with 50.1%, 48.1%, 37.7%, and 35.1%, respectively [ 5 , 12 , 13 , 14 ]. The lowest rates are reported in Sweden (14%), Denmark (14.7%), Canada (18.6%), and Finland (22%) [ 2 , 15 , 16 ].…”

“…Polydipsia and polyuria are early clinical signs of T1D, and in large clinical studies have been reported to occur in children in about 90% of cases [ 5 , 26 ]. These symptoms are usually present in children for about 12 to 25 days before diagnosis [ 26 , 27 , 28 ].…”

“…DKA is highly prevalent in both newly diagnosed and children previously known to have diabetes mellitus. The incidence of DKA at initial diagnosis ranges from 15% to 70% [ 1 , 3 , 4 , 5 ]. If T1D is detected early and prompt treatment is started, the progression to DKA will be avoided.…”

“…Recently published studies show large variations between countries in the incidence of DKA as the initial presentation of T1D [ 2 , 5 ]. There is also an increase in the incidence of T1D in children, as well as a growing trend of severe forms of DKA, especially during the COVID-19 pandemic [ 9 , 10 , 11 ].…”