The Frequency of Diabetic Ketoacidosis and Hyperglycemia in New Cases of Type 1 Diabetes Mellitus in Children Hospital of Qazvin City, Iran, during the Years 2006 to 2016

Document Type : Original Article (s)

Authors

1 Student of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 General Practitioner, Qazvin University of Medical Sciences, Qazvin, Iran

3 Associate Professor, Department of Pediatric Endocrinology AND Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Background: Type 1 diabetes mellitus (T1D) is the most common chronic endocrine-metabolic disorder of childhood and adolescence. Diabetic ketoacidosis (DKA) is one of the most important acute complications of T1D, and associated with significant morbidity and mortality. The aim of this study was to survey the frequency of DKA in new cases of T1D.Methods: Data from 144 new cases of T1D admitted to the children hospital of Qazvin City, Iran, between 2006 and 2016 were reviewed. The studied variables included age, sex, new case of disease, season, place of living, family history of T1D, cause of admission, duration of hospitalization, recovery of DKA, blood glucose level, and arterial pH at admission. The data were collected using a questionnaire, and analyzed using SPSS software.Findings: Out of 144 patients, 60.4% were girls. 84.3% of new patients admitted with DKA, and 15.7% with hyperglycemia. 24.7%, 24.6%, and 50.7% of patients were less than 5 years, 5 to 7 years, and ≥ 8 years, respectively. The highest incidence was in the autumn (31.6%). 11.9% of patients had a positive family history of T1D. The mean glucose level was 496.91 ± 154.38 mg/dl. Mean age at diagnosis was 7.38 ± 3.23 years. 2.5%, 28.0%, and 69.5% of patients had mild, moderate, and severe DKA, respectively. Mean days of hospitalization was 2.21 ± 7.54 days in ketoacidosis and 0.91 ± 4.66 in hyperglycemia, and the difference was significant (P < 0.001).Conclusion: A greater incidence of DKA in the onset of the disease was due to insufficient awareness of families about diabetes mellitus.

Keywords


  1. Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011; 343: d4092.
  2. Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, et al. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry. Pediatr Diabetes 2013; 14(6): 447-54.
  3. Duca LM, Wang B, Rewers M, Rewers A. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 2017; 40(9): 1249-55.
  4. Balmier A, Dib F, Serret-Larmande A, De Montmollin E, Pouyet V, Sztrymf B, et al. Initial management of diabetic ketoacidosis and prognosis according to diabetes type: A French multicentre observational retrospective study. Ann Intensive Care 2019; 9(1): 91.
  5. Negera GZ, Weldegebriel B, Fekadu G. Acute complications of diabetes and its predictors among adult diabetic patients at Jimma Medical Center, Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13: 1237-42.
  6. Baldelli L, Flitter B, Pyle L, Maahs DM, Klingensmith G, Slover R, et al. A survey of youth with new onset type 1 diabetes: Opportunities to reduce diabetic ketoacidosis. Pediatr Diabetes 2017; 18(7): 547-52.
  7. Jefferies C, Cutfield SW, Derraik JG, Bhagvandas J, Albert BB, Hofman PL, et al. 15-year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting (Auckland, New Zealand). Sci Rep 2015; 5: 10358.
  8. Szypowska A, Ramotowska A, Grzechnik-Gryziak M, Szypowski W, Pasierb A, Piechowiak K. High frequency of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. J Diabetes Res 2016; 2016: 9582793.
  9. Kliegman R, Behrman RE, Geme JWS, Stanton B, Tasker RC, Schor NF, et al. Nelson textbook of pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020.
  10. Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15(Suppl 20): 4-17.
  11. Cherubini V, Skrami E, Ferrito L, Zucchini S, Scaramuzza A, Bonfanti R, et al. High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: A nationwide longitudinal study, 2004-2013. Sci Rep 2016; 6: 38844.
  12. Robinson ME, Li P, Rahme E, Simard M, Larocque I, Nakhla MM. Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: A population-based retrospective cohort study. CMAJ Open 2019; 7(2): E300-E305.
  13. Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: A prospective study in a Tertiary Care Hospital. J Clin Diagn Res 2015; 9(6): OC01-OC04.
  14. Kamal Alanani NM, Alsulaimani AA. Epidemiological pattern of newly diagnosed children with type 1 diabetes mellitus, Taif, Saudi Arabia. ScientificWorldJournal 2013; 2013: 421569.
  15. Wojcik M, Sudacka M, Wasyl B, Ciechanowska M, Nazim J, Stelmach M, et al. Incidence of type 1 diabetes mellitus during 26 years of observation and prevalence of diabetic ketoacidosis in the later years. Eur J Pediatr 2015; 174(10): 1319-24.
  16. Naeem MA, Al-Alem HA, Al-Dubayee MS, Al-Juraibah FN, Omair A, Al-Ruwaili AS, et al. Characteristics of pediatric diabetic ketoacidosis patients in Saudi Arabia. Saudi Med J 2015; 36(1): 20-5.
  17. Bakhshayesh Karam M, Dabbaghmanesh AR, Dabbaghmanesh MH, Ranjbar Omrani GH. Precipitating factors, biological characteristics and clinical manifestations in patients admitted with diabetic ketoacidosis in Shiraz Nemazee Hospital. Iran J Endocrinol Metab 2012; 14(6): 531-7. [In Persian].
  18. Szypowska A, Skorka A. The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes 2011; 12(4 Pt 1): 302-6.
  19. Daga RA, Naik SA, Maqbool M, Laway BA, Shakir M, Rafiq W. Demographic and clinical characteristics of diabetes mellitus among youth Kashmir, India. Int J Pediatr 2015; 3(4.1): 739-47.
  20. Elding LH, Vehik K, Bell R, Dabelea D, Dolan L, Pihoker C, et al. Reduced prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in young children participating in longitudinal follow-up. Diabetes Care 2011; 34(11): 2347-52.
  21. de Vries L, Oren L, Lebenthal Y, Shalitin S, Lazar L, Phillip M. Decrease in frequency of ketoacidosis at diabetes onset over the past two decades - perspectives of a paediatric tertiary care centre. Diabet Med 2012; 29(8): e170-e175.
  22. Rogers MAM, Kim C, Banerjee T, Lee JM. Fluctuations in the incidence of type 1 diabetes in the United States from 2001 to 2015: A longitudinal study. BMC Med 2017; 15(1): 199.
  23. Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: A systematic review. Diabetologia 2012; 55(11): 2878-94.
  24. Klingensmith GJ, Tamborlane WV, Wood J, Haller MJ, Silverstein J, Cengiz E, et al. Diabetic ketoacidosis at diabetes onset: Still an all too common threat in youth. J Pediatr 2013; 162(2): 330-4.
  25. Maahs DM, Hermann JM, Holman N, Foster NC, Kapellen TM, Allgrove J, et al. Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany. Diabetes Care 2015; 38(10): 1876-82.
  26. Mohsenzadeh N, Mohsenzadeh A. Evaluation of the patients with diabetes mellitus in pediatric hospital of Khoramabad. Iran J Pediatr 2014; 24(2 Suppl): 8.
  27. Demirbilek H, Ozbek MN, Baran RT. Incidence of type 1 diabetes mellitus in Turkish children from the southeastern region of the country: A regional report. J Clin Res Pediatr Endocrinol 2013; 5(2): 98-103.
  28. Razavi Z. Frequency of ketoacidosis in newly diagnosed type 1 diabetic children. Oman Med J 2010; 25(2): 114-7.