Ann Pediatr Endocrinol Metab.  2022 Jun;27(2):126-133. 10.6065/apem.2142174.087.

Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis

• Seo YJ
• Kum CD
• Rho JG
• Shim YS
• Lee HS
• Hwang JS

• KMID: 2531277
• DOI: http://doi.org/10.6065/apem.2142174.087

Abstract

Purpose
We investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients.
Methods
Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed.
Results
Among 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up.
Conclusion
DKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.

Keyword

Diabetic ketoacidosis; Type 1 diabetes; Clinical outcomes

Figure

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  Fig. 1. Effect of diabetic ketoacidosis (DKA) at initial diagnosis on insulin demand and residual β-cell functions. Insulin demands were calculated as units/kg/day. Comparisons of insulin dosages at each time point were analyzed by post hoc tests with Bonferroni method. Data are expressed with mean±standard error values. ***P<0.001 (number of observed patients).

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  Fig. 2. Comparison of long-term clinical outcomes between the diabetic ketoacidosis (DKA) and non-DKA groups. (A) The serial glycated hemoglobin (HbA1c) levels were measured and analyzed every 6 months during the 5-year follow-up period. (B) Serial measurements of 24-hour urine microalbumin excretion were compared between DKA and non-DKA patients during a follow-up period of 5 years at 1-year intervals. (C) Change in height z-score from baseline to 5 years after the initiation of insulin treatment. Patients aged <1 year or >12 years were excluded from the comparison to facilitate the precise analysis of growth. Changes in serum TSH (D), T3 (E), and free T4 (F) levels in patients with type 1 diabetes mellitus were compared between the DKA and non-DKA groups. Comparisons of initial differences were analyzed by post hoc tests with Bonferroni method. Data are expressed with mean±standard error values. ***P<0.001.

Reference

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