title: Risk factors and predictors of uncontrolled hyperglycemia and diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus in Jeddah, western Saudi Arabia.
abstract: BACKGROUND
  Little is known about levels of glycemic control and risk factors for uncontrolled hyperglycemia in Saudi children with type 1 diabetes mellitus (T1DM). The aim of the present study was to identify levels of glycemic control, risk factors and predictors of uncontrolled hyperglycemia (HG) and diabetic ketoacidosis (DKA) in children with T1DM.
  
  
  METHODS
  A retrospective study was performed on Saudi children and adolescents with confirmed T1DM who were followed at the Pediatric Endocrinology Clinic of the Maternity and Children Hospital, Jeddah, from 2000 to 2014. Data collection included all possible factors that may be associated with uncontrolled T1DM. Patients were classified according to American Diabetes Association guidelines for target HbA1c levels per age group. Comparisons were made between well-controlled (WC) patients, HG patients, and DKA patients. Calculation of odds ratios and logistic regression allowed for estimation of the role of each risk factor in uncontrolled T1DM.
  
  
  RESULTS
  Only 31.2 % of children and adolescents with T1DM were well controlled. Better glycemic control was associated with age < 6 years, urban residence, and T1DM duration <5 years. Glycemic control was not affected by gender, insulin therapy, or comorbidities. The most significant independent predictors of hyperglycemia and DKA were poor compliance with a healthy lifestyle (adjusted hazards ratio [AHR] 28.94; 95 % confidence interval [CI] 8.37-100.04) and an excess intake of sweets (AHR 3.31; 95 % CI 1.54-7.11).
  
  
  CONCLUSIONS
  The most significant independent predictor for poor glycemic control (particularly DKA rather than hyperglycemia) in Saudi children and adolescents was poor compliance with a healthy lifestyle with an excessive intake of sweets.
authors.affiliation: Pediatric Department, Faculty of Medicine in Rabigh, King Adbulaziz University, Jeddah, Suadi Arabia.|Pediatric Department, Cairo University, Cairo, Egypt.
authors.forename: Mohamed Hesham
authors.initials: MH
authors.lastname: Sayed
authors.affiliation: Pediatric Department, Faculty of Medicine in Rabigh, King Adbulaziz University, Jeddah, Suadi Arabia.|Pediatric Department, Mansoura University Children's Hospital, Mansoura, Egypt.
authors.forename: Moustafa Abdelaal
authors.initials: MA
authors.lastname: Hegazi
authors.affiliation: Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia.
authors.forename: Khairyah
authors.initials: K
authors.lastname: Abdulwahed
authors.affiliation: Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia.
authors.forename: Khairya
authors.initials: K
authors.lastname: Moussa
authors.affiliation: Department of Community Medicine and Public Health, King Abdulaziz University, Jeddah, Suadi Arabia.|Department of Community Medicine and Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Basem Salama
authors.initials: BS
authors.lastname: El-Deek
authors.affiliation: Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia.
authors.forename: Hala
authors.initials: H
authors.lastname: Gabel
authors.affiliation: Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia.
authors.forename: Rana
authors.initials: R
authors.lastname: Ragheb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000209:etiology*; D019422:Dietary Sucrose / Q000008:administration & dosage*; D005260:Female; D005518:Food Preferences; D006442:Glycated Hemoglobin / Q000378:metabolism; D000070497:Healthy Lifestyle; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D013549:Sweetening Agents / Q000008:administration & dosage*
chemical_list: D019422:Dietary Sucrose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D013549:Sweetening Agents
keywords: adolescents; children; diabetic ketoacidosis; hyperglycemia; risk factors