Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group.

Abstract

The determinants of the degree of metabolic decompensation at the diagnosis of type 1 (insulin dependent) diabetes mellitus (IDDM) and the possible role of diabetic ketoacidosis in the preservation and recovery of residual P cell function were examined in 745 Finnish children and adolescents. Children younger than 2 years or older than 10 years of age were found to be more susceptible to diabetic ketoacidosis than children between 2 and 10 years of age (<2 It is well known that the capacity of residual 5 cells to secrete insulin is decreased at the time of diagnosis of IDDM, often improving in a few weeks after the initiation of exogenous insulin treatment.8'-`The extent of improvement in insulin secretory capacity has been observed to be associated with age at diagnosis,' degree of metabolic decompensation,9 mild clinical symptoms at diagnosis,2910 and strict initial blood glucose control.2 13 Diabetic ketoacidosis is a serious consequence of insufficient insulin secretion.'4 In addition to possible acute complications, it may also influence the later outcome of diabetes.To study the effect of age, sex, and socioeconomic factors on the clinical condition of the patient at the diagnosis of IDDM, and to find out whether metabolic decompensation at diagnosis is related to subsequent endogenous insulin secretion and impaired metabolic control, 745 Finnish children and adolescents, aged 0.8-14.9 years, were evaluated at the time of diagnosis of IDDM and then observed for two years. Methods PATIENTSAs a part of the Finnish nationwide 'Childhood diabetes in Finland' study,'5 801 probands younger than 15 years, diagnosed as having IDDM during the recruitment period from 1 September 1986 to 30 April 1989, were offered the possibility of participating in the study. Of these 745 had analyses of blood pH, serum C peptide concentrations, and blood glycated haemoglobin levels at the time of hospital admission. At the time of admission, a clinical examination including assessment of consciousness and dehydration was performed, and the parents were asked to fill out a questionnaire concerning the socioeconomic status of the family. The subjects were then followed up in their own outpatient clinics (n = 31) for two years. At six month intervals, the recommended amount of insulin was recorded, blood specimens werc taken for glycated haemoglobin and serum C peptide concentrations, and a clinical examination including height and weight recording was performed.The mean age of the probands was 8.4 years (range 0.8 to 14.9 years). The majority of them were males (n = 412; 55.3%). The subjects were divided into two groups: those with and without diabetic ketoacidosis at diagnosis. In the longitudinal study the groups were compared at the time of diagnosis and at six, 12, 18, and 24 months after diagnosis. LABORATORY MEASUREMENTSCapillary or venous blood pH was measured at the time of hospital admission. Diabetic

Clinical Demographic Patterns of Type 1 Diabetes in Saudi Children in Tabuk City, 2000-2010

“…This unique presentation may be explained by the fact that this category has a higher rate of respiratory and gastrointestinal infections, which could delay the diagnosis [28] [29]. Furthermore, underweight patients had a higher rate of DKA, which confirms its association with severely low β-cell function, as well as low serum C peptide concentrations, and indicates the presence of a small absolute β-cell mass and more aggressive β-cell destruction in infants and young children [30].…”

Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in Northern Finland

“…The frequency of DKA at the diagnosis of pediatric type 1 diabetes has been reported to vary from 15 to 67% in Europe and North America (2,3). A valid comparison of studies is, however, difficult because of the variable definitions of DKA used.…”

Geographical variation of presentation at diagnosis of Type I diabetes in children: the EURODIAB Study

“…With the exception of some reports identifying a young age at onset, risk factors for DKA are not known [1,10,26,27].…”