title: Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20years later.
abstract: OBJECTIVE
  To investigate on the relationship between severity of ketoacidosis, an important risk factor for C-peptide preservation, and long-term microvascular complications in childhood-onset type 1 diabetes mellitus (T1DM).
  
  
  METHODS
  230 childhood-onset diabetic patients (177 pre-pubertal), aged 7.0±3.8years followed for at least 15years after their diagnosis, were enrolled. Clinical and laboratory data at diagnosis, and C-peptide levels in a subset of patients, were compared with the severity of retinopathy and nephropathy, after a mean of 19.6±3.8years of disease. Digital retinal photographs were taken in all patients, and centrally graded. Repeated measurements of HbA1c and microalbuminuria for the whole duration of diabetes were collected in over half of the cases.
  
  
  RESULTS
  Out of 230 patients, those with the lowest age at diagnosis had the most severe DKA and clinical conditions (p<0.05), and lower C-peptide levels (p<0.0001) at diagnosis. There was a significant relationship between pH and clinical severity (r=-0.783, p<0.0001), and between pH and C-peptide levels (r=0.278, p<0.05). The severity of ketoacidosis had no relationship with subsequent lifetime HbA1c values and long-term microvascular complications. In logistic regression analysis, the only variables that independently influenced severity of retinopathy were lifetime HbA1c (B=0.838, p<0.001), duration of disease (B=0.208, p<0.005) and age at diagnosis (B=0.116, p<0.05).
  
  
  CONCLUSIONS
  The degree of metabolic derangement at diagnosis is not associated with retinopathy and nephropathy in childhood-onset T1DM. Age at diagnosis seems to be an important variable to be considered when evaluating the long-term effects of residual beta-cell function.
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: silvana.salardi@unibo.it.
authors.forename: Silvana
authors.initials: S
authors.lastname: Salardi
authors.affiliation: Diabetic Retinopathy Centre of the Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porta
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maltoni
authors.affiliation: Department of Pediatrics, University of Turin, Turin, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Cerutti
authors.affiliation: Diabetic Retinopathy Centre of the Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rovere
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tumini
authors.affiliation: Pediatric Unit, S. Chiara Hospital, Trento, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cauvin
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.affiliation: Department of Pediatrics, "Maggiore della Carità" Hospital Novara, University of Piemonte Orientale, Vercelli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cadario
authors.affiliation: Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: dʾAnnunzio
authors.affiliation: Meyer Pediatric Institute, University of Firenze, Firenze, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Toni
authors.affiliation: Pediatric Clinic, Insubria University, Varese, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvatoni
authors.affiliation: Pediatric Clinic, University of Cagliari, Cagliari, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Zedda
authors.affiliation: Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiaffini
mesh_terms: D017668:Age of Onset; D002096:C-Peptide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D016883:Diabetic Ketoacidosis / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002096:C-Peptide; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: C-peptide; HbA1c; childhood-onset diabetes; ketoacidosis; nephropathy; retinopathy