<p>Diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Tigray, Ethiopia: retrospective observational study</p>

Abstract

Background: Diabetic ketoacidosis (DKA) is the most severe acute complication of type 1 diabetes mellitus which results in increased risk of morbidity and mortality especially in developing countries. Objective: To assess prevalence and associated factors of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in hospitals of the Tigray region, Ethiopia. Methods: A facility based retrospective observational study design was conducted in newly diagnosed type 1 diabetic children and adolescents up to the age of 18 years who were registered in 13 general and two referral hospitals from January 1, 2013 to December 30, 2017. The diagnosis of diabetic ketoacidosis was made with the criteria below, Children presenting with polysymptoms, weight loss, vomiting, dehydration, and also the indirect signs or effects of acidosis on respiratory and central nervous systems like Kussmaul breathing, lethargy or coma and biochemically random blood sugar level >11 ml/L, glucosuria and urine ketone >+1 and diagnosed with type 1 diabetes for the first time. Descriptive, Mann–Whitney U and logistic regression analysis were carried out to describe and identify the associated factors with diabetic ketoacidosis. Results: More than three-quarters, 258/328 (78.7%) of the newly diagnosed type 1 diabetes patients, presented with diabetic ketoacidosis at initial diagnosis. Median age of diabetic ketoacidosis patients was 11 years. The patients with diabetic ketoacidosis were younger than nondiabetic ketoacidosis patients (11 vs 13 years, P =0.002). The mortality rate of diabetic ketoacidosis was 4.3%. Young age, presence of precipitating factors and symptoms of DKA/diabetes were found to be highly associated with diabetic ketoacidosis at initial diagnosis. Conclusions: The prevalence of diabetic ketoacidosis was alarmingly high. Young age group patients, precipitating factors and the presence of symptoms of diabetes/DKA like excessive drinking, vomiting and fatigue were highly associated with diabetic ketoacidosis.

Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

“…More than three-quarter of the children with DKA were males; similar to the reports from India [26] and Ethiopia [19]. However, the majority of other studies reported female preponderance [5,14,17,24,27].…”

“…However, the majority of other studies reported female preponderance [5,14,17,24,27]. The reason for this disparity in gender is not clear but could be because infection was a major triggering factor of DKA in our study, similar to the Indian [26] and Ethiopian study [19]; given the biological and genetic vulnerability of males to infection [28], which also tends to be severe in them, thus resulting in infection-caused inflammation, pro-inflammatory cytokine release, and counter-regulatory hormones that lead to insulin resistance/deficiency and metabolic deterioration to DKA [25]. It could also, to some extent, be attributed to the higher societal value for male children in the study area, which has a positive impact on health seeking behaviour, and to a little extent, related to the gender distribution of the T1D population in our unit; wherein males were slightly more than females.…”

“…There are few reports on DKA in the childhood diabetic population in Nigeria [10,14,[17][18] and other African countries [1,19,20]. Most of these reports focused on DKA at onset of T1D only.…”

A Retrospective Analysis of Children and Adolescents With Diabetic Ketoacidosis in the Intensive Care Unıt: Is It Significant that the Blood Ketone Level Becomes Negative in Diabetic Ketoacidosis?

“…T1DM is a disease with an increasing incidence in children and adolescents worldwide [4][5][6]. In 16.5-78% of newly diagnosed T1DM patients, DKA is still the first cause of admission to the hospital [4][5][6][7][8][9][10][11][12][13][14]. Low socioeconomic conditions, lack of family history of diabetes, living in countries with a low prevalence of DM, and being young are risk factors for DKA in newly diagnosed patients with T1DM [3].…”

“…Rapid reduction of intravascular hyperosmolality causes swelling of cells and hypokalemia, leading to an increase in morbidity and mortality rates associated with DKA [3,17]. Although mortality rates have declined from 0.15% to 0.3% over the years, there is still a mortality rate of 4-12% reported in some countries [3,14,18]. Despite the decline in mortality rates from DKA, it is still responsible for more than half of all deaths in children and adolescents with diabetes [19,20].…”