Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

Fredheim, Siri; Johannesen, Jesper; Johansen, Anders; Lyngsøe, L.; Rida, Heba; Andersen, Marie Louise Max; Lauridsen, Mette Høj; Hertz, Birgitte; Birkebæk, Niels H; Olsen, Birthe Susanne; Mortensen, Henrik B.; Svensson, Jannet

doi:10.1007/s00125-013-2850-z

Cited by 79 publications

(97 citation statements)

References 34 publications

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“…It is known that younger age at diagnosis of DKA is associated with lower HbA1c but higher glucose concentrations2122. We too found a similar observation with the cohort from Kuwait.…”

Section: Resultssupporting

confidence: 88%

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Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait

Shaltout

Channanath

Thanaraj

et al. 2016

Sci Rep

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We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0–14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1st January 2011 and 31st December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2–14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27–0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait.

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“…It is known that younger age at diagnosis of DKA is associated with lower HbA1c but higher glucose concentrations2122. We too found a similar observation with the cohort from Kuwait.…”

Section: Resultssupporting

confidence: 88%

“…In our study, the frequency of severe DKA (8.8%) is comparable and significantly lower than in Spain (17.8%)27 or France (14.8%)28, but was much higher than that reported from Denmark (1.7%)29.…”

Section: Discussioncontrasting

confidence: 58%

Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait

Shaltout

Channanath

Thanaraj

et al. 2016

Sci Rep

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“…In mainland Italy, DKA frequency at time of diabetes diagnosis (41.9%) was consistent with recent reports from other countries, such as France (43.9%)14 and Brazil (42.3%)15, and with a recent Italian study based on two years of observation (38.5%)7. The DKA frequency in Italian children at diagnosis of type 1 diabetes was somewhat higher than that reported in Austria (34.0%)5, Germany (21.1%)3, New Zealand (25.0%)16 and the U.S. (31.1%)17 and, disappointingly, close to twice that reported in Finland (22.4%)18 and Denmark (17.9%)19 and in Canada (18.6%)20. However, it should be noted that there were minor differences in the definition of DKA used in the studies.…”

Section: Discussionmentioning

confidence: 67%

High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: a nationwide longitudinal study, 2004–2013

Cherubini

Skrami²,

Ferrito

et al. 2016

Sci Rep

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This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004–2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis. Overall, 9,040 cases were ascertained. DKA frequency was 40.3% (95%CI: 39.3–41.4%), with 29.1% and 11.2% for mild/moderate and severe DKA, respectively. Severe DKA increased significantly during the period (OR = 1.03, 95%CI: 1.003–1.05). Younger-age children and children living in Southern Italy compared to Central Italy were at significantly higher risk of DKA and severe DKA. Family history of type 1 diabetes and residence in Sardinia compared to Central Italy were significantly associated with a lower probability of DKA and severe DKA. The high frequency of ketoacidosis in Italy over time and high variability among age groups and geographical area of residence, strongly suggests a continuing need for nationwide healthcare strategies to increase awareness of early detection of diabetes.

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“…We have demonstrated that metabolic control has improved7 and severe hypoglycemic events have decreased 8,9. Furthermore, diabetic ketoacidosis at disease onset is associated with worse metabolic control and higher daily insulin requirement for equal HbA1c values (ie, higher insulin dose-adjusted [IDA]A1c)10 several years after diagnosis 11…”

Section: Examples Of Researchmentioning

confidence: 99%

Danish Registry of Childhood and Adolescent Diabetes

Svensson¹,

Cerqueira²,

Kjærsgaard³

et al. 2016

CLEP

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AimThe aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes.Study populationThe study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included.Main variablesThe variables in the registry are the quality indicators, demographic variables, associated conditions, diabetes classification, family history of diabetes, growth parameters, self-care, and treatment variables. The quality indicators are selected based on international consensus of measures of good clinical practice. The indicators are metabolic control as assessed by HbA1c, blood pressure, albuminuria, retinopathy, neuropathy, number of severe hypoglycemic events, and hospitalization with ketoacidosis.Descriptive dataThe number of children diagnosed with diabetes is increasing with ∼3% per year mainly for type 1 diabetes (ie, 296 new patients <15 years of age were diagnosed in 2014). The disease management has changed dramatically with more children treated intensively with multiple daily injections, insulin pumps, and increased number of self-monitored blood glucose values per day. These initiatives have resulted in a significant improvement in HbA1c over the years and a decrease in the number of children experiencing severe hypoglycemia, diabetic nephropathy, and retinopathy.ConclusionThe systematic collection of data in DanDiabKids documents improved quality of care over the last 12 years, despite a substantial increase in the number of patients cared for by pediatric departments in Denmark, fulfilling the purpose of the registry.

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Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

Cited by 79 publications

References 34 publications

Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait

Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait

High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: a nationwide longitudinal study, 2004–2013

Danish Registry of Childhood and Adolescent Diabetes

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