The Incidence and Severity of Paediatric Diabetic Ketoacidosis Presenting to a Metropolitan Hospital in Western Sydney
A 10-Year Retrospective Review
DOI:
https://doi.org/10.15605/jafes.040.01.02Keywords:
type 1 diabetes mellitus, diabetic ketoacidosis, paediatricsAbstract
Objectives. To report the incidence and clinical characteristics of paediatric patients presenting with diabetic ketoacidosis to the Emergency Department (ED) with new and pre-existing type 1 diabetes mellitus (T1DM).
Methodology. A ten-year retrospective data analysis was performed on children under 16 years presenting to the ED with T1DM from January 2010. Demographic and laboratory data were extracted to determine the rates of DKA. Comparative statistics were performed between age groups and pre-existing and newly diagnosed T1DM patients.
Results. A total of 196 children with T1DM were included. The mean age of the cohort was 9.3 ± 4.0 years, with female predominance (54%, p = 0.38). Most (60%) were newly diagnosed with T1DM, of which 38% presented in DKA. Amongst the total cohort, 43% presented in DKA.
The older children accounted for 50% of the DKA presentations in the newly diagnosed cohort. Amongst the younger age group, 42% presented with severe DKA. There were higher rates of T1DM in areas of relative socioeconomic advantage.
Conclusion. Children with T1DM presented with unacceptably high rates of DKA and posed a significant medical, psychosocial and financial burden on families and medical services. These findings suggest that a prospective public health campaign to reduce rates of DKA is warranted.
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References
1. de Bock M, Jones TW, Fairchild J, Mouat F, Jefferies C. Children and adolescents with type 1 diabetes in Australasia: An online survey of model of care, workforce and outcomes. J Paediatr Child Health. 2019;55(1):82-6. https://pubmed.ncbi.nlm.nih.gov/30051636 https://doi.org/10.1111/jpc.14122
2. Australian Institute of Health and Welfare 2024. Diabetes: Australian Institute of Health and Welfare; 2024. https://www.aihw.gov.au/reports/diabetes/diabetes
3. Frohlich-Reiterer E, Elbarbary NS, Simmons K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2022;23(8):1451-67. https://pubmed.ncbi.nlm.nih.gov/36537532 https://doi.org/10.1111/pedi.13445
4. Holder M, Ehehalt S. Significant reduction of ketoacidosis at diabetes onset in children and adolescents with type 1 diabetes-The Stuttgart Diabetes Awareness Campaign, Germany. Pediatr Diabetes. 2020;21(7):1227-31. https://pubmed.ncbi.nlm.nih.gov/32579294 https://doi.org/10.1111/pedi.13064
5. Rabbone I, Maltoni G, Tinti D, et al. Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0-18 years. Arch Dis Child. 2020;105(4):363-6. https://pubmed.ncbi.nlm.nih.gov/31597646 https://doi.org/10.1136/archdischild-2019-316903
6. Patwardhan R, Gorton S, Vangaveti VN, Yates J. Diabetic ketoacidosis incidence in children at first presentation of type 1 diabetes at an Australian regional hospital: the effect of health professional education. Pediatr Diabetes. 2018;19(5):993-9. https://pubmed.ncbi.nlm.nih.gov/29484782 https://doi.org/10.1111/pedi.12666
7. Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23(7):835-56. https://pubmed.ncbi.nlm.nih.gov/36250645 https://doi.org/10.1111/pedi.13406
8. Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) 2016: Australian Bureau of Statistics; 2018. https://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa
9. Rittiphairoj T, Owais M, Ward ZJ, Reddy CL, Yeh JM, Atun R. Incidence and prevalence of type 1 diabetes and diabetic ketoacidosis in children and adolescents (0-19 years) in Thailand (2015-2020): a nationwide population-based study. Lancet Reg Health West Pac. 2022;21:100392. https://pubmed.ncbi.nlm.nih.gov/35169761 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8829760 https://doi.org/10.1016/j.lanwpc.2022.100392
10. Xin Y, Yang M, Chen XJ, Tong YJ, Zhang LH. Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China. J Paediatr Child Health. 2010;46(4):171-5. https://pubmed.ncbi.nlm.nih.gov/20546479 https://doi.org/10.1111/j.1440-1754.2009.01657.x
11. Mahmud FH, Elbarbary NS, Frohlich-Reiterer E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2018;19(Suppl 27):275-86. https://pubmed.ncbi.nlm.nih.gov/30066458 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748835 https://doi.org/10.1111/pedi.12740
12. Lawrence JM, Divers J, Isom S, et al. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017. JAMA. 2021;326(8):717-27. https://pubmed.ncbi.nlm.nih.gov/34427600 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385600 https://doi.org/10.1001/jama.2021.11165
13. Wandell PE, Carlsson AC. Time trends and gender differences in incidence and prevalence of type 1 diabetes in Sweden. Curr Diabetes Rev. 2013;9(4):342-9. https://pubmed.ncbi.nlm.nih.gov/23721159 https://doi.org/10.2174/15733998113099990064
14. Lai CK, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83. https://pubmed.ncbi.nlm.nih.gov/19237391 https://doi.org/10.1136/thx.2008.106609
15. Ampt A, van Gemert T, Craig ME, Donaghue KC, Lain SB, Nassar N. Using population data to understand the epidemiology and risk factors for diabetic ketoacidosis in Australian children with type 1 diabetes. Pediatr Diabetes. 2019;20(7):901-8. https://pubmed.ncbi.nlm.nih.gov/31291024 https://doi.org/10.1111/pedi.12891
16. 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(11):2878-94. https://pubmed.ncbi.nlm.nih.gov/22933123 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464389 https://doi.org/10.1007/s00125-012-2690-2
17. Jefferies C, Cutfield SW, Derraik JG, et al. 15-year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting (Auckland, New Zealand). Sci Rep. 2015;5:10358. https://pubmed.ncbi.nlm.nih.gov/25989414 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650806 https://doi.org/10.1038/srep10358
18. 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. https://pubmed.ncbi.nlm.nih.gov/21737470 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131115 https://doi.org/10.1136/bmj.d4092
19. Cherubini V, Grimsmann JM, Akesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63(8):1530-41. https://pubmed.ncbi.nlm.nih.gov/32382815 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351855 https://doi.org/10.1007/s00125-020-05152-1
20. Bizzarri C, Benevento D, Ciampalini P, et al. Clinical presentation and autoimmune characteristics of very young children at the onset of type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2010;23(11):1151-7. https://pubmed.ncbi.nlm.nih.gov/21284328 https://doi.org/10.1515/jpem.2010.180
21. Hardikar N, Power T, Leong GM, Liu A, Bhurawala H. Primary care providers' experience in the management of paediatric type 1 diabetes in Western Sydney, New South Wales. Aust J Gen Pract. 2023;52(7):464-71. https://pubmed.ncbi.nlm.nih.gov/37423244 https://doi.org/10.31128/AJGP-03-22-6381
22. Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics. 2014;133(4):e938-45. https://pubmed.ncbi.nlm.nih.gov/24685959 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074618 https://doi.org/10.1542/peds.2013-2795
23. Haynes A, Bulsara MK, Bower C, Codde JP, Jones TW, Davis EA. Independent effects of socioeconomic status and place of residence on the incidence of childhood type 1 diabetes in Western Australia. Pediatr Diabetes. 2006;7(2):94-100. https://pubmed.ncbi.nlm.nih.gov/16629715 https://doi.org/10.1111/j.1399-543X.2006.00153.x
24. Begum M, Chittleborough C, Pilkington R, Mittinty M, Lynch J, Penno M, et al. Incidence of type 1 diabetes by socio-demographic characteristics among South Australian children: whole-of-population study. J Paediatr Child Health. 2020;56(12):1952-8. https://pubmed.ncbi.nlm.nih.gov/32932553 https://doi.org/10.1111/jpc.15104
25. Tauschmann M, Hermann JM, Freiberg C, et al. Reduction in diabetic ketoacidosis and severe hypoglycemia in pediatric type 1 diabetes during the first year of continuous glucose monitoring: a multicenter analysis of 3,553 subjects from the DPV registry. Diabetes Care. 2020;43(3):e40‐2. https://pubmed.ncbi.nlm.nih.gov/31969340 https://doi.org/10.2337/dc19-1358
26. van den Boom L, Karges B, Auzanneau M, et al. Temporal trends and contemporary use of insulin pump therapy and glucose monitoring among children, adolescents, and adults with type 1 diabetes between 1995 and 2017. Diabetes Care. 2019;42(11):2050‐6. https://pubmed.ncbi.nlm.nih.gov/31488568 https://doi.org/10.2337/dc19-0345
27. Gerhardsson P, Schwandt A, Witsch M, et al. The SWEET project 10‐year benchmarking in 19 countries worldwide is associated with improved HbA1c and increased use of diabetes technology in youth with type 1 diabetes. Diabetes Technol Ther. 2021;23(7):491‐9.
https://pubmed.ncbi.nlm.nih.gov/33566729 https://doi.org/10.1089/dia.2020.0618
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