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

Abstract

Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011–2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.

Prevalence and clinical features of severe diabetic ketoacidosis treated in pediatric intensive care unit: a 5-year monocentric experience

“…Few studies reported data on rates of hospitalizations in PICU at T1D onset. Our prevalence of PICU admission due to severe DKA is lower than that found by a recent single-center study from Croatia [ 26 ]. Differences between rates of DKA-related hospitalizations in pediatric critical care areas may be related to disparities in territorial availability of PICU or to different levels of expertise on DKA management in pediatric non-intensive units.…”

Emergency Department Presentations of Diabetic Ketoacidosis in a Large Cohort of Children

“…However, given that the cohorts were treated at the same PECARN hospitals over the same time-period, we believe that the timing of the laboratory tests was similar for the two study cohorts. Additionally, we reported laboratory results at presentation and did not present changes with DKA treatment (e.g., expected drops in potassium with correction of metabolic acidosis) [36,37]. Fourth, we were unable to abstract SES indicators (either household income or highest caregiver education) for the retrospective cohort from existing medical records, limiting our ability to evaluate these demographic factors in the full study cohort.…”

Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review

“…Several studies report a clear increase in the incidence of T1D since the beginning of the worldwide spread of the SARS-CoV-2 virus [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ]. According to a meta-analysis by Rahmati et al [ 114 ], the global new-onset of childhood T1D rate in 2020 was 32.39 per 100,000 children, clearly higher in comparison with 2019 (19.73 per 100,000 children) [ 114 ].…”

“…In a cohort study in seven U.S. centers, T1D was reported in 781,419 children and adolescents aged 0–17 years with laboratory-confirmed COVID-19 [ 115 ]. However, most of the above-mentioned studies did not find a direct cause–effect link between COVID-19 infection and T1D onset [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ].…”