Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus

Mallare, Johanna T.; Cordice, Candida C.; Ryan, Barbara A.; Carey, Dennis E.; Kreitzer, Paula M.; Frank, Graeme R.

doi:10.1177/000992280304200704

Cited by 84 publications

(79 citation statements)

References 17 publications

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“…A shortcoming of our investigation is that the registry contained no data on socioeconomic factors such as family income or parental educational level or on ethnicity on an individual basis, which have been described as factors predisposing to the development of DKA [7,8,15,[20][21][22]. We found an interesting regional difference among Austrian provinces, with the highest risk in Tyrol and Vienna.…”

Section: Discussionmentioning

confidence: 86%

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

2010

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Aim The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)) on a population basis in the whole of Austria. Methods A prospective population-based incidence study (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH<7.3 and severe DKA as pH<7.1. Time trends were estimated using linear regression models. Results During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p< 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p<0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/ 100,000 (p<0.0001), no significant change in the prevalence of DKA at manifestation was observed. Conclusions The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset.

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Section: Discussionmentioning

confidence: 86%

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

2010

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“…Recent onset bed wetting is seen as a sign of stress in school children. Literature reveals up to 15%-86% of children with DKA not been diagnosed as diabetic at the first physician consultation [43,44,48,49] . Delay due to missed diagnosis is universal in DKA among children from developed and developing countries.…”

Section: Renal Failure In Dkamentioning

confidence: 99%

Risk factors for mortality in children with diabetic keto acidosis from developing countries

Varadarajan¹

2014

WJD

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Diabetic keto acidosis (DKA) is the major cause for mortality in children with Diabetes mellitus (DM). With increasing incidence of type 1 DM worldwide, there is an absolute increase of DM among children between 0-14 year age group and overall incidence among less than 30 years remain the same. This shift towards younger age group is more of concern especially in developing countries where mortality in DKA is alarmingly high. Prior to the era of insulin, DKA was associated with 100% mortality and subsequently mortality rates have come down and is now, 0.15%-0.31% in developed countries. However the scenario in developing countries like India, Pakistan, and Bangladesh are very different and mortality is still high in children with DKA. Prospective studies on DKA in children are lacking in developing countries. Literature on DKA related mortality are based on retrospective studies and are very recent from countries like India, Pakistan and Bangladesh. There exists an urgent need to understand the differences between developed and developing countries with respect to mortality rates and factors associated with increased mortality in children with DKA. Higher mortality rates, increased incidence of cerebral edema, sepsis, shock and renal failure have been identified among DKA in children from developing countries.Root cause for all these complications and increased mortality in DKA could be delayed diagnosis in children from developing countries. This necessitates creating awareness among parents, public and physicians by health education to identify symptoms of DM/DKA in children, in order to decrease mortality in DKA. Based on past experience in Parma, Italy it is possible to prevent occurrence of DKA both in new onset DM and in children with established DM, by simple interventions to increase awareness among public and physicians. Key words: Diabetic keto acidosis; Mortality; Cerebral edema; Sepsis; Shock; Delayed diagnosis Core tip: Mortality in Diabetic keto acidosis (DKA) among children from developed countries is due to cerebral edema and is very low. The mortality in DKA among children from developing countries is due to higher incidence of cerebral edema, sepsis, shock and renal failure. Delayed diagnosis is the root cause for high mortality in children with DKA from developed countries. There is an urgent need to increase the awareness about diabetes among the public and physicians.Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes 2014; 5(6): 932-938 Available from:

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“…Various risk factors have been reported to precipitate DKA in diabetic patients. They include infections, non-compliance to treatment and co-morbid states like stroke, chronic renal failure, chronic liver disease and acute pancreatitis (Mallare et al, 2003;Lin et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania

Iddi

Francis

Jaka

et al. 2017

Tanzania J Hlth Res

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Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality. This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania. Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed. Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul's breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died. Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients.

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Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus

Cited by 84 publications

References 17 publications

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

Risk factors for mortality in children with diabetic keto acidosis from developing countries

Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania

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