Young children (&lt;5 yr) and adolescents (&gt;12 yr) with type 1 diabetes mellitus have low rate of partial remission: diabetic ketoacidosis is an important risk factor

Bowden, Sasigarn A; Duck, Mary M; Hoffman, Robert R.

doi:10.1111/j.1399-5448.2008.00376.x

Cited by 111 publications

(122 citation statements)

References 17 publications

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“…The observed frequency of DKA in our population is in line with countries geographically near Denmark. A higher DKA rate was observed in the youngest age group (<5 years), which is consistent with previous studies undertaken in countries with a high incidence of type 1 diabetes [4,10,14,16,29]. The very young children (<2 years) had an undesirably high prevalence of DKA (48.3%), comparable with register studies from Sweden, Finland and Germany (39.5-54.9%) [15,30,31].…”

Section: Discussionsupporting

confidence: 80%

“…In many patients, the clinical course of type 1 diabetes during the first year is characterised by residual endogenous insulin secretion (the remission phase) [16,22,23]. The heterogeneity of the remission phase and its duration are influenced by several factors.…”

Section: Introductionmentioning

confidence: 99%

“…A worldwide increase in type 1 diabetes has been reported [8,9], and is particularly evident in younger children (<5 years). In addition, the youngest children are at increased risk of presenting with metabolic deterioration [3,4,[10][11][12] due to delayed diagnosis, leading to advanced deterioration at onset [13,14] and/or a more aggressive aetiology [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

et al. 2013

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Aims/hypothesis We investigated the long-term impact of diabetic ketoacidosis (DKA) at onset on metabolic regulation and residual beta cell function in a Danish population with type 1 diabetes. Methods The study is based on data from DanDiabKids, a Danish national diabetes register for children. The register provides clinical and biochemical data on patients with type 1 diabetes diagnosed in 1996-2009 and then followed-up until 1 January 2012. Repeated-measurement models were used as statistical methods.Results The study population comprised 2,964 children <18 years. The prevalence of DKA at diagnosis was 17.9%. Of the total subjects, 8.3% had mild, 7.9% had moderate and 1.7% had severe DKA. DKA (moderate and severe) was associated with increased HbA 1c (%) levels (0.24; 95% CI 0.11, 0.36; p=0.0003) and increased insulin dose-adjusted HbA 1c (IDAA 1c , 0.51; 95% CI 0.31, 0.70; p<0.0001) during followup, after adjustment for covariates. Children without a family history of diabetes were more likely to present with DKA (19.2% vs 8.8%, p<0.0001); however, these children had a lower HbA 1c (%) level over time (−0.35; 95% CI −0.46, −0.24; p<0.0001). Continuous subcutaneous insulin infusion (CSII) was associated with a long-term reduction in HbA 1c , changing the effect of DKA, after adjustment for covariates (p<0.0001). Conclusions/interpretation DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA 1c and IDAA 1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

et al. 2013

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“…This correlates with the results of other authors. Previous studies showed that children below the age of 5 had a low partial remission (Bowden et al 2008). Moreover, no remission was observed in children under the age of 3 (Abdul-Rasoul et al 2006).…”

Section: Discussionmentioning

confidence: 99%

Low Frequency of Regulatory T Cells in the Peripheral Blood of Children with Type 1 Diabetes Diagnosed under the Age of Five

Szypowska

Stelmaszczyk-Emmel

Demkow

et al. 2012

Arch. Immunol. Ther. Exp.

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The highest annual increase in the incidence of type 1 diabetes (T1D) in children under the age of 5 years and aggressive process of β-cell destruction in this age group indicate the need to assess the immune system. The aim of this study was to evaluate regulatory T cells (Tregs) frequency in the peripheral blood of children <5 years of age with newly diagnosed T1D in comparison with diabetic children diagnosed at a later age and healthy controls. 40 children with newly diagnosed T1D (20 children <5 years of age and 20 older patients) and 40 age-matched controls were included in this study. Flow cytometric analysis of Tregs was performed using the following markers: CD4, CD25, CD127, FoxP3, IL-10, and TGF-β. Apoptosis was measured using anti-active caspase 3 monoclonal antibody. Fasting C-peptide and HbA1c were monitored as well. We showed that T1D children <5 years had lower C-peptide concentration than diabetic children ≥5 years of age (0.32 vs. 0.80 ng/ml, respectively, p = 0.0005). There was lower frequency of CD4(+)CD25(high)CD127(low)FoxP3(+) Tregs in T1D children <5 years than ≥5 years of age (0.87 vs. 1.56 %, respectively, p = 0.017). Diabetic children <5 years had lower CD4(+)CD25(high)CD127(low)FoxP3(+), CD4(+)CD25(high)IL-10, and CD4(+)CD25(high)TGF-β Tregs compared to age-matched controls. There was no difference in Tregs apoptosis between the examined groups. This study highlights the distinctiveness of diabetes in children <5 years of age. Understanding the differences of immune system activity in the young diabetic children would open the way to identify children at risk for T1D and enables the use of novel forms of intervention.

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“…Unfortunately, the first presentation of 10% to 70% of newly diagnosed children with DM1 is DKA (6). Also, these children encounter more problems than those newly diagnosed with DM1 including lower remission rate and poorer glycemic control (7,8).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis

Mirsadraee¹,

Khajedaluee²,

Vakili³

et al. 2016

J Pediatr Rev

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Background: Diabetes mellitus type 1 is one of the most prevalent endocrine diseases in pediatrics. Diabetic ketoacidosis is considered as one of the most threatening clinical pictures of DM1, especially if occurred as the first presentation of DM1 in children. Objectives: The current study aimed to identify factors which may play a role in DKA onset in children. Methods: This case-control study included all patients under 18 years old who referred to department of pediatrics endocrinology at Mashhad University Hospital (Imam Reza) from January 2013 to December 2015 as newly diagnosed patients with DM1. Patients who fulfilled DKA criteria at diagnosis were considered as DKA group and those who referred with other presentations were considered as control group (non-DKA group). Data were analyzed by SPSS software ver. 16. Results: During the study period, 97 (39.2% male) newly diagnosed patients were included as DKA group. Accordingly 97 genderand age-matched patients were added as non-DKA group. The most prevalent symptoms in both groups were polyuria (91.88%) and polydipsia (88.66%). Fever and cold symptoms were significantly higher in the DKA group (P < 0.001 and P =0.005, respectively). Hemoglobin A1c level was significantly higher in the DKA group (P = 0.001), while body mass index was significantly lower in the DKA group (P = 0.045). Fever and father's education level were the most important risk and protective factors in the DKA onset in newly diagnosed patients with DM1 (adjusted OR = 10.1, 95% CI = 2.9-35.3; P < 0.001 and adjusted OR = 0.5, 95% CI = 0.3 -0.9 and P = 0.019, respectively). Conclusions:In conclusion, a recent febrile illness was found as the strongest risk factor and father's education level as the main protective factor in the DKA to diagnose children with DM1. The study findings suggested that DKA is a severe form of DM1 instead of a neglected or misdiagnosed disease.

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Young children (<5 yr) and adolescents (>12 yr) with type 1 diabetes mellitus have low rate of partial remission: diabetic ketoacidosis is an important risk factor

Cited by 111 publications

References 17 publications

Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels

Low Frequency of Regulatory T Cells in the Peripheral Blood of Children with Type 1 Diabetes Diagnosed under the Age of Five

Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis

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