Prevalence and characteristics of type 2 diabetes mellitus in 9-18 year-old children with diabetic ketoacidosis.
OBJECTIVE
To estimate the prevalence of type 2 diabetes mellitus (DM2) in 9-18 year-old children with diabetic ketoacidosis (DKA) and to describe the presenting biochemical characteristics and response to standardized DKA treatment.


METHODS
Data were collected from a consecutive sample of 9-18 year-old children presenting with DKA. DKA was defined as hyperglycemia and ketosis with an initial pH <7.3, or bicarbonate <15 mmol/l. Patients were classified as having DM2 if they had negative autoantibody status and normal or elevated fasting C-peptide.


RESULTS
The prevalence of DM2 in patients with DKA was 13.0% (6.1-23.3%). There was no significant difference in the presenting pH (7.14 vs 7.15), but blood glucose was higher (735 vs 587 mg/dl) in patients with DM2, than in patients with type 1 DM (DM1). The duration of insulin infusion until resolution of acidosis (17.3 vs 13.2 h) and intensive care unit stay (2.4 vs 1.6 days) were longer in patients with DM2. Seven of the nine patients with DM2 did not require insulin at 1-year follow-up.


CONCLUSIONS
Children with DM2 can present with DKA and constitute a significant percentage in the above 9-year age group. The need for insulin must be carefully re-evaluated as DKA resolves in these patients. Adolescents with DM2 and their families need to be educated about DKA.
Sapru
Anil
A
Pediatric Critical Care Medicine, University of California, San Francisco, CA 94143, USA. anil.sapru@ucsf.edu
Gitelman
Stephen E
SE
Bhatia
Suruchi
S
Dubin
Ruth F
RF
Newman
Thomas B
TB
Flori
Heidi
H
D000293:Adolescent; D001786:Blood Glucose; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D015995:Prevalence
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin