Agnieszka Szypowska1, Katarzyna Dżygało1, Marta Wysocka-Mincewicz2, Artur Mazur3, Lucyna Lisowicz3, Iwona Ben-Skowronek4, Joanna Sieniawska4, Bożenna Klonowska5, Dorota Charemska5, Jolanta Nawrotek6, Irena Jałowiec6, Artur Bossowski7, Milena Jamiołkowska7, Beata Pyrżak8, Izabela Rogozińska8, Mieczysław Szalecki2,9. 1. Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland. 2. Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland. 3. II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland. 4. Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland. 5. Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland. 6. Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland. 7. Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland. 8. Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland. 9. Faculty of Medicine and Health Sciences, UJK, Kielce, Poland.
Abstract
AIM: Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS: The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS: We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS: The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.
AIM: Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS: The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS: We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS: The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.