The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus.
OBJECTIVE
Diabetic ketoacidosis (DKA) is still a severe complication associated with significant morbidity and mortality. The aim of this study was to determine the predictors of DKA in children with newly diagnosed type 1 diabetes mellitus (T1DM).


METHODS
The study group consisted of new-onset type 1 diabetic patients admitted to our hospital between January 2006 and March 2008. One hundred and eighty-seven children were identified (95 females and 92 males) and their mean age was 8.9 ± 4.6 yr (0.8-17.8). Hemoglobin A1c, blood gases, and fasting c-peptide level were evaluated in all children. DKA was defined as a capillary pH < 7.3 and blood glucose >11 mmol/L.


RESULTS
At the time of T1DM diagnosis, 26% of children had DKA. Misdiagnosis was significantly associated with the incidence of DKA. In the group with DKA, c-peptide level was significantly lower than in the group without DKA (p = 0.003.) The most prone to DKA were children under 2 yr of age (n = 14). In this age group, DKA was present in 71% of individuals and the lowest c-peptide level was observed compared to older children (p < 0.0001). There was significant correlation between the c-peptide level and age of children (r = 0.41, p < 0.0001).


CONCLUSIONS
The incidence of DKA among newly diagnosed patients with T1DM remains unacceptably high and indicates greater necessity of medical alertness for this diagnosis, especially in the youngest children. Children under 2 yr of age remain the most prone to DKA, which may be related to delay in diagnosis and more aggressive β-cell destruction.
Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland. agnieszka.szypowska@gmail.com
Agnieszka
A
Szypowska
Agata
A
Skórka
D000293:Adolescent; D000375:Aging; D002096:C-Peptide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000209:etiology*; D003951:Diagnostic Errors; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007223:Infant; D008297:Male; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors
D002096:C-Peptide; D006442:Glycated Hemoglobin