Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents

Lee, Hye Jin; Yu, Hyeoh Won; Jung, Hae Woon; Lee, Young Ah; Kim, Jae Hyun; Chung, Hye Rim; Yoo, Juhyun; Kim, Eun Young; Yu, Jeesuk; Shin, Choong Ho; Yang, Sei Won; Lee, Seong Yong

doi:10.3346/jkms.2017.32.2.303

Cited by 32 publications

(24 citation statements)

References 23 publications

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“…Secondly, age-related differences in the frequency of DKA at T1D onset was observed in this study, subsequently, almost half of children aged 0-4 developed DKA, as opposed to older individuals who had a lower prevalence of DKA. Comparable high frequency of DKA in younger children with new-onset diabetes was reported from other studies worldwide [7,9,10,12]. It seems to be important, because common signs of T1D often resemble symptoms of other disease.…”

Section: Discussionmentioning

confidence: 64%

“…Diabetic ketoacidosis (DKA), one of the most life-threatening severe T1D complications, is highly prevalent in newly diagnosed pediatric patients and its frequency at diagnosis varies from 12.8% to 80% depending on a geographic location [7]. Moreover, younger children, aged < 5 years, are at greater risk of developing DKA [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Commonly, risk factors for DKA in children with newly diagnosed T1D include: young age (< 5 years), diagnostic error and delayed treatment, lack of health insurance (USA), lower socioeconomic status, preceding infection, whereas, factors such as first degree relative with T1D, higher parental education and higher background incidence of T1D are consider as a protective factors [8][9][10]14].…”

Section: Introductionmentioning

confidence: 99%

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Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Niechciał

Skowrońska

Michalak

et al. 2019

Clinical Diabetology

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Background. Diabetic ketoacidosis (DKA) is a life-threatening condition frequently present at type 1 diabetes diagnosis (T1D). Younger children are at greater risk of developing this acute complication. It is alarming due to worldwide rise in T1D incidence with the greatest increase in children aged < 5 years. The aim of this study was to identify the prevalence of DKA and factors related to its occurrence in children at T1D diagnosis from Wielkopolska province in Poland. Methods. The study cohort comprised 735 children (girls: 329; boys: 406) aged 0-18 years with new onset T1D admitted to one hospital between 2009 and 2014. The mean age at diagnosis was 9.3 years. DKA was defined as blood pH < 7.30. To confirm autoimmune diabetes origin typical autoantibodies were tested. Results. DKA was diagnosed in 36% of patients with newly diagnosed T1D. DKA occurred significantly more often in children aged < 4 years (p = 0.001). The highest prevalence of DKA was associated with symp-toms' duration (> 28 days) (p = 0.014) and diabetes misdiagnosis (p = 0.001). Autoantibody against zinc transporter 8 was detected significantly more often in children with DKA (p = 0.044). In the group with DKA, glycated hemoglobin level was significantly higher (p = 0.0004), while insulin and C-peptide levels were lower (p = 0.0001 and p = 0.0001, respectively). Conclusions. The prevalence of DKA is high and its severity is substantial in children with newly diagnosed T1D from Wielkopolska province. Diabetes misdiagnosis, symptoms' duration and age under 4 years are the most common risk factors of DKA development at T1D onset. Autoantibody against zinc transporter 8 is associated with acute T1D onset.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Niechciał

Skowrońska

Michalak

et al. 2019

Clinical Diabetology

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“…A low level of maternal education was associated with a higher risk of DKA in 401 children under 15 years of age in Lithuania (18) while in a series of 474 children under 17 years of age in Poland an association between delayed diagnosis of type 1 diabetes and level of maternal education (19) was not found. Likewise, in a study conducted in Korea, no association was found between the level of parental education and the risk of DKA in a group of 361 children, however, the children of parents with low education showed an increased risk of severe DKA (20).…”

Section: Parental Education and Occupational Levelsmentioning

confidence: 87%

Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014–2016 Nationwide Study of 2,679 Italian Children

et al. 2020

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This study aims to compare the frequency of Diabetic Ketoacidosis (DKA) at diagnosis in 2014-2016 with the one previously reported in 2004-2013; and to assess the association between family socioeconomic status and DKA at type 1 diabetes (T1D) diagnosis in children <15 years of age from 2014 to 2016. Methods: This nationwide, population-based, observational study included 2,679 children diagnosed with T1D from 54 Italian centers for pediatric diabetes during 2014-2016. The ISPAD criteria for DKA were used as a standard reference. The overall and by age frequency of DKA between the two time periods were compared. The association between family socioeconomic status and DKA was assessed using multiple logistic regression analysis. Results: Nine hundred and eighty nine children had DKA (36.9, 95% CI: 35.1-38.8). The frequency of DKA was significantly lower in 2014-2016 in comparison to 2004-2013 (40.3, 95% CI: 39.3-41.4, p = 0.002). The probability of having DKA at diagnosis was lower in mothers with a high level of education (OR = 0.69, 95% CI: 0.51-0.93) or a high level of occupation (OR = 0.76, 95% CI: 0.58 0.99), and in fathers with a high level Gesuita et al. Socioeconomic Inequalities Increase DKA of occupation (OR = 0.72, 95% CI: 0.55-0.94). Children living in Southern Italy had a higher probability of diagnosis with severe DKA than children living in Central Italy. Conclusion: There was a decrease in the frequency of DKA in children diagnosed with T1D under 15 years of age during 2014-2016. However, DKA frequency remains unacceptably high. This study demonstrated that socioeconomic inequalities, measured as low education and occupational levels, were associated with an increased probability of DKA at T1D diagnosis.

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“…Approximately 10~70% of these patients experience DKA [14], which, in children, Factors that contribute to the incidence of DKA include poorly metabolic control [16] and a rapid decrease in pancreatic beta cell function [17]. In a recent study, age under 12 years, lower serum C-peptide level, preceding infection, and delayed diagnosis were strongly related to DKA; and severe DKA was increased in situations where there was limited parental education level and a prior episode of infection [18].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

et al. 2017

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Background: Diabetic ketoacidosis (DKA) is an acute complication of pediatric type 1 diabetes mellitus (T1DM). We aimed to determine the risk factors and clinical characteristics of children and adolescents with DKA. Methods: We retrospectively evaluated 59 episodes of DKA in 43 patients who were hospitalized for DKA between January 2006 and December 2015. DKA was classified as mild, moderate, or severe, according to patient history of DKA. The clinical and laboratory characteristics of these subgroups were compared. Results: The average patient age was 11.98 ± 4.40 years (range, 1.3~17.9 years). Moderate episodes were the most common, with 21 episodes (35.6%), followed by 19 severe (32.2%) and 19 mild episodes (32.2%). Significant differences were observed between the subgroups regarding their characteristics of aggravated. Severe DKA episodes were more often observed during the winter season. Recurrent DKA cases were determined in 31 episodes (52.5%) who were significantly older, had higher body mass index, and lower serum C-peptide levels than the newly diagnosed DKA group. Female patients experienced severe and moderate cases more frequently (P = 0.041), which included two deaths. Only blood glucoseCorresponding author: Min Sun Kim Department of Pediatrics, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, E-mail: children@jbnu.ac.kr Received: Feb. 20, 2017; Revised: Jun. 5, 2017; Accepted: Jul. 18, 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents

Cited by 32 publications

References 23 publications

Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014–2016 Nationwide Study of 2,679 Italian Children

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

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