title: High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study.
abstract: OBJECTIVE
  Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17.
  
  
  METHODS
  The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS).
  
  
  RESULTS
  We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001).
  
  
  CONCLUSIONS
  The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.
authors.affiliation: Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Szypowska
authors.affiliation: Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Dżygało
authors.affiliation: Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Wysocka-Mincewicz
authors.affiliation: II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Mazur
authors.affiliation: II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Lisowicz
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Ben-Skowronek
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sieniawska
authors.affiliation: Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland.
authors.forename: Bożenna
authors.initials: B
authors.lastname: Klonowska
authors.affiliation: Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Charemska
authors.affiliation: Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Nawrotek
authors.affiliation: Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland.
authors.forename: Irena
authors.initials: I
authors.lastname: Jałowiec
authors.affiliation: Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Bossowski
authors.affiliation: Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland.
authors.forename: Milena
authors.initials: M
authors.lastname: Jamiołkowska
authors.affiliation: Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Pyrżak
authors.affiliation: Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Izabela
authors.initials: I
authors.lastname: Rogozińska
authors.affiliation: Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.|Faculty of Medicine and Health Sciences, UJK, Kielce, Poland.
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Szalecki
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011044:Poland / Q000453:epidemiology
keywords: adolescent; child; diabetes complications; diabetes mellitus, type 1; diabetic ketoacidosis; incidence