title: Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia.
abstract: Diabetic ketoacidosis (DKA) has significant morbidity and mortality and is common at diagnosis in children. The aim of this study was to determine the frequency and clinical characteristics of DKA over a 20-year period among children diagnosed with type 1 diabetes mellitus (T1DM) at University children's hospital in Belgrade, Serbia. The study population comprised of 720 patients (366 boys) diagnosed with type 1 diabetes aged <18 years between January 1992 and December 2011. Of all patients diagnosed with T1DM, 237 (32.9 %) presented with DKA. The majority had either mild (69.6 %) or moderate (22.8 %) DKA. Sixty (55.0 %) of all children under 5 years had DKA compared to sixty-two (20.9 %) in the 5- to 10-year-old group and one hundred fifteen (36.6 %) in the 11- to 18-year-old patients (p<0.01), while 2.5 % of the entire DKA cohort were in real coma. During the later 10-year period, children less often had DKA at diagnosis compared with the earlier 10-year period (28.0 vs. 37.4 %) (p<0.01), but the frequency of severe DKA was higher in the age group <5 year and in the age group >11 year during 2002-2011, compared with the earlier 10-year period (12.9 vs. 3.4 %, p<0.01 and 17.1 vs. 3.8 %, p<0.01).
  
  
  CONCLUSIONS
  The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.
authors.affiliation: School of Medicine, Belgrade University, Belgrade, Serbia, maja.jesic@udk.bg.ac.rs.
authors.forename: Maja D
authors.initials: MD
authors.lastname: Ješić
authors.forename: Miloš M
authors.initials: MM
authors.lastname: Ješić
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljević
authors.forename: Vera
authors.initials: V
authors.lastname: Zdravković
authors.forename: Vladislav
authors.initials: V
authors.lastname: Bojić
authors.forename: Mira
authors.initials: M
authors.lastname: Vranješ
authors.forename: Danijela
authors.initials: D
authors.lastname: Trifunović
authors.forename: Svetislav
authors.initials: S
authors.lastname: Necić
authors.forename: Silvija
authors.initials: S
authors.lastname: Sajić
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D055771:Serbia / Q000453:epidemiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D063128:Tertiary Health Care
chemical_list: D001786:Blood Glucose