Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia

Jesic, Maja; Jesic, Milos; Stanisavljević, Dejana; Zdravković, Vera; Bojic, Vladislav; Vranješ, Mira; Trifunović, D.; Necić, S; Sajic, Silvija

doi:10.1007/s00431-013-2083-7

Cited by 18 publications

(9 citation statements)

References 28 publications

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“…The non-significant decrease in the proportion of presentations in DKA in our patient population is also similar to the worldwide trends [22]. While decrease in DKA rates have been noted in some countries [22][23][24] many developed countries continue to report high rates [25][26][27]. Factors like degree of awareness of symptoms of diabetes among parents and primary care physicians have been proposed to affect the risk of developing DKA at diagnosis [27] but targeted intervention with a community-based information program, generally considered successful in preventing ketoacidosis [28], failed to decrease the rates of DKA in one study [25].…”

Section: Discussionsupporting

confidence: 81%

Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Dayal

Saini

Jayashree

et al. 2015

Int J Diabetes Dev Ctries

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Increase in the incidence of Type 1 diabetes (T1D) over last several decades has been reported worldwide. There is a dearth of data on incidence/prevalence of T1D in children from India. We studied the trends in incidence of T1D amongst children attending a tertiary care pediatric hospital of North India over last 12 years and the changes in incidence, patterns of presentation and disease outcomes during this period by retrospective analysis of patient records and hospital census data. The study population comprised of 647 children with onset of T1D below 16 years who attended the hospital from April, 2001 to March, 2013. There was a consistent increase in the total number of T1D patients every year. The increase in the proportion of younger (<5 years) patients (16.2 % in 2001-02 versus 35.2 % in 2012-13) was significantly more as compared to other age categories. The percentage of patients who presented with DKA decreased every year (65 % in 2001-02 to 36.3 % in 2012-13). Younger (<5 years) patients were two to three times more likely to present in DKA than older (>15 years) patients (mean yearly percentage 60.3 versus 25 %). The proportion of patients presenting during winter months was almost double than the average of any of the 3 seasons (39 versus 20.3 %). The overall mortality was 1.7 %. In conclusion, the number of patients with T1D has shown an increase although the severity of presentation has declined. Marked seasonality in presentation indicates some unidentified environmental factors triggering the onset of disease in our patient population.

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Section: Discussionsupporting

confidence: 81%

Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Dayal

Saini

Jayashree

et al. 2015

Int J Diabetes Dev Ctries

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show abstract

“…This is in accordance with other reports of children with new-onset T1DM 35–37 and is possibly because of closer supervision by caretakers of younger children. Though we might have expected the older children, who were symptomatic, on average, for almost a month prior to presenting in DKA, to have a more significant degree of acidosis and higher cortisol levels than the younger children, they did not.…”

Section: Discussionsupporting

confidence: 93%

Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus

Williams

Fazzio

Oberfield

et al. 2017

Clin Pediatr (Phila)

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There is little data documenting cortisol levels in children with diabetic ketoacidosis (DKA), despite the fact that untreated adrenal insufficiency (AI) could worsen the outcome of DKA. In this cross-sectional study, we assessed serum cortisol levels in 28 children with DKA and new onset type 1 diabetes mellitus evaluated at our center over a 5-year period. Average duration of diabetes-related symptoms was positively associated with age (P = .002), and significantly lower hemoglobin A1c levels were observed in the youngest children. The mean cortisol level was 40.9 mg/dL, with a range of 7.8 to 119 mg/dL. Cortisol levels were found to be inversely associated with serum pH (P = .007). There was no difference in the clinical outcome of the 4 patients who had cortisol levels less than 18 mg/dL. Overall, we did not find clinical or laboratory evidence of diminished cortisol reserve; however, the possibility of AI must be kept in mind when treating children with DKA.

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“…The data confirm the results of other studies indicating that age was not significantly associated with the severity of DKA (28)(29)(30). In contrast Jesic et al (31) reported that severe DKA was more frequent in the age group < 5 years.…”

Section: Discussionmentioning

confidence: 83%

Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

Razavi

Hamidi

2017

Iran J Pediatr

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Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for the majority of diabetesrelated morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus (T1DM). Objectives: To investigate the demographic, clinical characteristics, and outcomes of DKA in young patients with established T1DM and newly diagnosed diabetes in a tertiary referral hospital. Methods: Data from all T1DM patients diagnosed with DKA episodes in the pediatric endocrine unit at Besat university hospital, Hameden, Iran during 2006 -2013 were reviewed in a retrospective study. The data collected includes the demographic data (age, sex, place of residence, first presentation and established T1DM), clinical presentation (main presenting symptoms, average duration of presenting symptoms before hospitalization, precipitating factors, severity of DKA, level of consciousness), laboratory parameters (blood sugar, arterial blood gases, urine ketones, serum electrolytes) and the outcome. DKA was defined as a glucose level higher than 250 mg/dL, pH < 7.30, bicarbonate > 15 mmol/L and ketonuria. Data was entered and analyzed on SPSS version 16. A P value less than 0.05 were defined as statistically significant. Results: The study population comprised 72 children satisfying the inclusion criteria of the study. Mean age of patients was 9.4

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Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia

Abstract: The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.

Cited by 18 publications

References 28 publications

Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus

Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

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