Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
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Beata Małachowska
, Katarzyna Małachowska , Joanna Pietrzyk , Wojciech Fendler , Dorota Rzeznik and Wojciech Mlynarski
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).
Conclusion: Rapid transfer to the specialist center plays a crucial role in the prevention of DKA.
Acknowledgments
The project was funded by the Innovative Economy Operational Program-Activity 1.2 (TEAM Program coordinated by the Foundation for Polish Science). The authors have no conflicts of interest to disclose. We would like to thank Dr. Vishnu Pradeep for the linguistic correction of the manuscript.
References
1. Jarosz-Chobot P, Polanska J, Szadkowska A, Kretowski A, Bandurska-Stankiewicz E, et al. Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia 2011;54:508–15.10.1007/s00125-010-1993-4Search in Google Scholar PubMed PubMed Central
2. Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011;343:d4092.10.1136/bmj.d4092Search in Google Scholar PubMed PubMed Central
3. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001;85:16–22.10.1136/adc.85.1.16Search in Google Scholar PubMed PubMed Central
4. Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia 2012;55:2878–94.10.1007/s00125-012-2690-2Search in Google Scholar PubMed PubMed Central
5. Fendler W, Baranowska-Jazwiecka A, Hogendorf A, Walenciak L, Szadkowska A, et al. Weekend matters: Friday and Saturday admissions are associated with prolonged hospitalization of children. Clin Pediatr (Phila) 2013;52:875–8.10.1177/0009922812446014Search in Google Scholar PubMed
6. Fendler W, Borowiec M, Baranowska-Jazwiecka A, Szadkowska A, Skala-Zamorowska E, et al. Prevalence of monogenic diabetes amongst Polish children after a nationwide genetic screening campaign. Diabetologia 2012;55:2631–5.10.1007/s00125-012-2621-2Search in Google Scholar PubMed PubMed Central
7. Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 2009;10(Suppl 12):118–33.10.1111/j.1399-5448.2009.00569.xSearch in Google Scholar PubMed
8. Nawarycz T, Ostrowska-Nawarycz L. Body mass index in the school age children and youth from the city of Lodz. Pol Merkur Lekarski 2007;23:264–70.Search in Google Scholar
9. Levy-Marchal C, Patterson CC, Green A. Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and Dibetes. Diabetologia 2001;44(Suppl 3):B75–80.10.1007/PL00002958Search in Google Scholar
10. Charemska D, Przybyszewski B, Klonowska B. Estimation of the severity of metabolic disorders in children with newly diagnosed insulin dependent diabetes mellitus (IDDM). Med Wieku Rozwoj 2003;7:261–70.Search in Google Scholar
11. Mlynarski W, Zmyslowska A, Kubryn I, Perenc M, Bodalski J. [Factors involved in ketoacidosis at the onset of type 1 diabetes in childhood]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2003;9:23–8.Search in Google Scholar
12. Olak-Bialon B, Deja G, Jarosz-Chobot P, Buczkowska EO. The occurrence and analysis of chosen risk factors of DKA among children with new onset of DMT1. Pediatr Endocrinol Diabetes Metab 2007;13:85–90.Search in Google Scholar
13. Pawlowicz M, Birkholz D, Niedzwiecki M, Balcerska A. Difficulties or mistakes in diagnosing type 1 diabetes in children? – demographic factors influencing delayed diagnosis. Pediatr Diabetes 2009;10:542–9.10.1111/j.1399-5448.2009.00516.xSearch in Google Scholar PubMed
14. Razavi Z. Frequency of ketoacidosis in newly diagnosed type 1 diabetic children. Oman Med J 2010;25:114–7.10.5001/omj.2010.31Search in Google Scholar PubMed PubMed Central
15. Ješić MD, Ješić MM, Stanisavljević D, Zdravković V, Bojić V, et al. Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia. Eur J Pediatr 2013;172:1581–5.10.1007/s00431-013-2083-7Search in Google Scholar PubMed
16. de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, et al. Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents. Diabet Med 2013;30:1360–6.10.1111/dme.12252Search in Google Scholar PubMed
17. Klingensmith GJ, Tamborlane WV, Wood J, Haller MJ, Silverstein J, et al. Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth. J Pediatr 2013;162:330–4 e1.10.1016/j.jpeds.2012.06.058Search in Google Scholar PubMed
18. Marigliano M, Morandi A, Maschio M, Costantini S, Contreas G, et al. Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes. Eur J Endocrinol 2013;168:107–11.10.1530/EJE-12-0541Search in Google Scholar PubMed
19. Oyarzabal Irigoyen M, Garcia Cuartero B, Barrio Castellanos R, Torres Lacruz M, Gómez Gila AL, et al. Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature. Pediatr Endocrinol Rev 2012;9:669–71.Search in Google Scholar
20. Uçar A, Saka N, Baş F, Sukur M, Poyrazoğlu S, et al. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted. J Pediatr Endocrinol Metab 2013;26:1059–65.10.1515/jpem-2013-0060Search in Google Scholar PubMed
21. King BR, Howard NJ, Verge CF, Jack MM, Govind N, et al. A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes. Pediatr Diabetes 2012;13:647–51.10.1111/j.1399-5448.2012.00896.xSearch in Google Scholar PubMed
22. Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, et al. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care 1999;22:7–9.10.2337/diacare.22.1.7Search in Google Scholar PubMed
23. Lansdown AJ, Barton J, Warner J, Williams D, Gregory JW, et al. Prevalence of ketoacidosis at diagnosis of childhood onset Type 1 diabetes in Wales from 1991 to 2009 and effect of a publicity campaign. Diabet Med 2012;29:1506–9.10.1111/j.1464-5491.2012.03638.xSearch in Google Scholar PubMed
24. Kaminski BM, Klingensmith GJ, Beck RW, Tamborlane WV, Lee J, et al. Body mass index at the time of diagnosis of autoimmune type 1 diabetes in children. J Pediatr 2013;162:736–40 e1.10.1016/j.jpeds.2012.09.017Search in Google Scholar PubMed
©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?