Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients

Vakharia, Janaki D.; Agrawal, Sungeeta; Molino, Janine; Topor, Lisa Swartz

doi:10.4158/ep-2019-0351

Cited by 7 publications

(25 citation statements)

References 33 publications

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“…This may be justi ed by the higher levels of HbA1c found in these patients. This nding is in agreement with the study by Vakharia J et al that found an association between family history of diabetes and a higher risk for diabetic ketoacidosis recurrence in youth with T1D [33,29].…”

Section: Discussionsupporting

confidence: 93%

“…In our study, family history of diabetes was a predictor of reduction and improvement of HbA1c after insulin pump therapy. Other studies suggested that having a family history of diabetes may be associated with worse glycemic control and higher HbA1c levels [27][28][29]. As higher levels of HbA1c are associated with a greater improvement in HbA1c, this may partially explain this nding.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Neves

Carvalho

2021

Endocrine

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Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D. MethodsWe conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12 and 36 months) were evaluated for outcomes of glycemic control and safety.The association of baseline predictors with outcomes was analyzed using linear and logistic regression models. ResultsWe evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age and duration of T1D. Higher baseline HbA1c, family history of diabetes and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c and psychological/psychiatric disorders were predictors of ketoacidosis. ConclusionBene ts of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia and psychological/psychiatric disorders were predictors of outcomes and may allow the identi cation of patients who bene t most from insulin pump therapy or who are at increased risk of complications.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Neves

Carvalho

2021

Endocrine

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“…It indicates a need for complete care and strict vigilance of T1DM patients for compliance of treatment, dietary recommendations, regular physical activity, and immediate access to a healthcare facility in case of any irregular event. In established T1DM patients, DKA recurrence may be more likely to reveal a positive family history of DM with an emphasis on general awareness and community education programs for formerly unidentified populations at high risk of DKA [ 10 ]. Pediatric diabetes awareness programs and screening campaigns at schools should be administered on a periodic basis to target and educate youth and their parents for special care in childhood that may minimize the incidence of DKA and promote early diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…The major risk factors in newly diagnosed patients are younger age, family history of T1DM, poor socioeconomic class, lack of parental education, and less accessibility to medical services. For known T1DM patients, a lapse of insulin intake for one or more reasons, being peripheral to medical center resources because of their remote location, and improper insulin intake through a pump are the possible risk factors [ 9 , 10 ]. The common precipitating factors of DKA are abdominal pain, nausea, vomiting, fever, dehydration, polydipsia, polyuria, polyphagia, weight loss, drowsiness, loss of consciousness, tachypnea and deep and sighing respiration [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetic Ketoacidosis and its Severity Predictors in Type 1 Diabetic Children; A 10-year Experience of A Teaching Hospital in Saudi Arabia

Albuali

2022

Review of Diabetic Studies

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OBJECTIVE: Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive Care Unit (PICU) in a large teaching hospital in the Eastern region of Saudi Arabia. METHODS: We conducted a retrospective, analytical study at King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia. We retrieved the complete medical records of 2234 children who were admitted to the PICU during the 10-year period of 2010 through 2019. The children included those with polydipsia, polyurea, abdominal pain, vomiting, dehydration, and weight loss, as well as breathing disturbances due to acidosis and CNS issues such as lethargy or coma and elevated blood glucose level, > 200 mg/dL [> 11.1 mmol/L], venous pH 7.3, serum total CO2 15 mmol/L, and blood- hydroxybutyrate concentration 3 mmol/L or moderate or severe ketonuria. RESULTS: Out of 2234 PICU admissions, 211 (9.4%) were diagnosed with DKA. A persistent increase in the rate of DKA ended up at 14.1% in 2019 (p = .005). The incidence of DKA was 88/2234 (3.93%). The severity of DKA was as follows: 130 (61.6%) had severe and 81 (38.4%) had moderate DKA. Excessive sweet intake without adding insulin in 83 (39.3%) patients and unhealthy lifestyles (35.1%) were the best predictors of severe DKA (p = .001). CONCLUSION: Over a 10-year period, the DKA pattern was persistently rising and slightly falling, which ended up at the significantly highest rate of 14.1% in 2019. URTI, pneumonia, unhealthy lifestyle, and excess sweet intake were significant precipitating factors associated with severe DKA.

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“…In one study comparing individuals with zero episodes of repeat diabetic ketoacidosis with those who had experienced three or more episodes, a higher proportion of people who were non‐Hispanic black were observed in the repeat group (46.5% as compared to 16.1% in the zero episode group) 41 . Furthermore, in univariate analysis, Vakharia et al 43 observed that non‐Hispanic black individuals experienced 80% more admissions for repeat diabetic ketoacidosis than non‐Hispanic white individuals. However, this association was not significant at multivariate analysis ( p = 0.2).…”

Section: Resultsmentioning

confidence: 99%

Psychosocial factors associated with repeat diabetic ketoacidosis in people living with type 1 diabetes: A systematic review

2021

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Aim To systematically review the literature concerning the psychosocial factors associated with repeat diabetic ketoacidosis for people living with type 1 diabetes. Methods PsycInfo, Web of Science, CINAHL, PubMed and ASSIA were searched according to a registered study protocol (PROSPERO CRD42020167381). Data were extracted into a coding spreadsheet, and findings were synthesised narratively. Included papers were also subject to a quality assessment. Results The search yielded 548 unique articles, of which 22 met inclusion criteria for this review. There was considerable variance across studies with regard to design, quality and outcome measured. Nevertheless, there was relatively consistent evidence to suggest that repeat diabetic ketoacidosis in type 1 diabetes is associated with female gender, adolescent to young adult age range, lower socio‐economic status and poor mental health. Some evidence was also observed for the role of ethnicity and, for children and young people at least, family, social and behavioural issues. However, this was limited by issues of methodological rigour and scant investigation. Conclusions The review identified four psychosocial factors that appear to play a key role in the cycle of repeat diabetic ketoacidosis. Individuals with these factors present may benefit from targeted support and interventions by specialist healthcare professionals. Knowledge and understanding in this area would be considerably enhanced via increased use of prospective study designs and greater consistency in the operationalisation of variables across studies.

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Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients

Cited by 7 publications

References 33 publications

Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Diabetic Ketoacidosis and its Severity Predictors in Type 1 Diabetic Children; A 10-year Experience of A Teaching Hospital in Saudi Arabia

Psychosocial factors associated with repeat diabetic ketoacidosis in people living with type 1 diabetes: A systematic review

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