title: Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is a life-threatening condition occurring in patients with newly developed type 1 diabetes.
  
  
  OBJECTIVE
  To investigate the factors associated with the risk of DKA and the duration of diabetic symptoms reflected by glycated hemoglobin (HbA1c) level.
  
  
  METHODS
  The study group included 652 children admitted to our department with newly diagnosed diabetes. Clinical data were collected from available medical records. The distance between the patient's house and the hospital was calculated using a Google Maps-based distance calculator.
  
  
  RESULTS
  Ketoacidosis of any severity was present in 189 patients (30.14%). The mean HbA1c level at admission was 11.76%±2.57%. Children admitted directly to the specialist center were less likely to develop DKA: odds ratio (OR) (95% confidence interval, 95% CI)=0.45 (0.26-0.78). Older age exerted a protective effect: OR (95% CI)=0.92 (0.87-0.96). Patients living farther from the center had higher HbA1c levels: β (95% CI)=0.10 (0.01-0.18). Having a parent with diabetes promoted an earlier diagnosis of diabetes, as evidenced by lower HbA1c: β (95% CI): -0.18 (-0.27 to -0.96) and marginally lower risk of DKA: OR (95% CI)=0.50 (0.22-1.12).
  
  
  CONCLUSIONS
  Rapid transfer to the specialist center plays a crucial role in the prevention of DKA.
authors.forename: Beata
authors.initials: B
authors.lastname: Małachowska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Małachowska
authors.forename: Joanna
authors.initials: J
authors.lastname: Pietrzyk
authors.forename: Wojciech
authors.initials: W
authors.lastname: Fendler
authors.forename: Dorota
authors.initials: D
authors.lastname: Rzeznik
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mlynarski
mesh_terms: D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D065840:Protective Factors; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human