Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014–2016 Nationwide Study of 2,679 Italian Children

Gesuita, Rosaria; Maffeis, Claudio; Bonfanti, Riccardo; Cardella, Francesca; Citriniti, Felice; d’Annunzio, Giuseppe; Franzese, Adriana; Iafusco, Dario; Iannilli, Antonio; Lombardo, Fortunato; Maltoni, Giulio; Patera, Ippolita Patrizia; Piccinno, Elvira; Predieri, Barbara; Rabbone, Ivana; Ripoli, Carlo; Toni, Sonia; Schiaffini, Riccardo; Bowers, Renee; Cherubini, Valentino; Study, Diabetes for Dka

doi:10.3389/fped.2020.575020

Cited by 24 publications

(29 citation statements)

References 26 publications

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“…In line with these studies, we observed that DKA was more common among the youngest children (<2 years of age), who also had the highest rates of severe DKA. The latter observation is in agreement with the published evidence, as DKA at diagnosis in younger children (especially <2 years of age) is usually more severe, and it is often a consequence of delayed treatment or diagnostic error ( 1 – 3 , 27 , 33 ).…”

Section: Discussionsupporting

confidence: 91%

“…The main limitation of the present study was the lack of key demographic data, such as access to medical services and medical insurance, and in particular socioeconomic status, as numerous studies have reported that greater socioeconomic deprivation is associated with an increased risk of DKA at T1D diagnosis (9,11,27,32,(44)(45)(46)(47)(48)(49)(50)(51). Of note, a number of studies have shown an increased risk of DKA among ethnic minorities (11,23,45,50,52), and since ethnicity and socioeconomic status are strongly intertwined (53), our homogeneous cohort consisting solely of Han Chinese patients likely mitigated some of the potential effects of socioeconomic status.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, in a retrospective study of youth newly diagnosed with T1D in New York (USA) in 2010–2013, there was a modest decline in the rate of DKA compared to a similar study 15 years earlier (from 38% to 29%) ( 26 ). More recently, a comprehensive nationwide study in Italy also reported a slight reduction in average DKA rates at T1D diagnosis from 40.3% in 2004–2013 to 36.9% in 2014–2016, with a more marked reduction observed among children aged <5 years ( 27 ). A greater decline was reported in Saudi Arabia, from 55.1% to 32.5% between 2005 and 2015 ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…In children with new-onset T1D, young age has been identified often as an important risk factor for DKA at diabetes presentation ( 4 , 10 , 27 ). Studies in Canada, Italy, and the UK have reported higher rates of DKA at T1D diagnosis in young children aged 0–4 years ( 25 , 27 ) and <2 years ( 28 ), respectively. A meta-analysis involving 32 studies found that children aged <2 years of age had 3 times the risk of presenting with DKA compared to older children ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

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10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

et al. 2021

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BackgroundDiabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes (T1D), and a leading cause of death in children aged <15 years with new-onset T1D.Aimsi) to assess the incidence of DKA in children and adolescents newly diagnosed with T1D over a 10-year period at a large regional center in China; and ii) to examine the clinical symptoms and demographic factors associated with DKA and its severity at diagnosis.MethodsWe carried out a retrospective audit of a regional center, encompassing all youth aged <16 years diagnosed with T1D in 2009–2018 at the Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China). DKA and its severity were classified according to ISPAD 2018 guidelines.Results681 children were diagnosed with T1D, 50.1% having DKA at presentation (36.0% mild, 30.0% moderate, and 33.9% severe DKA). The number of patients diagnosed with T1D progressively rose from approximately 39 cases/year in 2009–2010 to 95 cases/year in 2017–2018 (≈2.5-fold increase), rising primarily among children aged 5–9 years. DKA incidence was unchanged but variable (44.8% to 56.8%). At T1D diagnosis, 89% of patients reported polyuria and 91% polydipsia. Children presenting with DKA were more likely to report vomiting, abdominal pain, and particularly fatigue. DKA was most common among the youngest children, affecting 4 in 5 children aged <2 years (81.4%), in comparison to 53.3%, 42.7%, and 49.3% of patients aged 2–4, 5–9, and ≥10 years, respectively. Children with severe DKA were more likely to report vomiting, fatigue, and abdominal pain, but less likely to report polyuria, polydipsia, and polyphagia than those with mild/moderate DKA. Rates of severe DKA were highest in children aged <2 years (51.1%).ConclusionsThe number of children diagnosed with T1D at our regional center increased over the study period, but DKA rates were unchanged. With 9 of 10 children reporting polyuria and polydipsia prior to T1D diagnosis, increasing awareness of this condition in the community and among primary care physicians could lead to earlier diagnosis, and thus potentially reduce rates of DKA at presentation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

et al. 2021

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“…DKA can also develop in patients with well-known T1DM; it is referred to as recurrent DKA, and its frequency varies among different countries, reaching up to 8 per 100 person-years (15). Correct and timely diagnosis of T1DM and also careful follow-up of patients are the cornerstones for DKA prevention, which should be a goal for pediatricians (16,17). Several data records report an increased frequency of DKA during the COVID-19 pandemic (18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Increased Frequency of Diabetic Ketoacidosis: The Link With COVID-19 Pandemic

d’Annunzio

Bassi

Rose

et al. 2022

Front. Clin. Diabetes Healthc.

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AimsDiabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic.Patients and MethodsWe retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C).ResultsWe analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04).ConclusionsAn increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns.

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