Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature

• Published in: Pediatric endocrinology reviews : PER Vol. 9; no. 3; p. 669
• Main Authors: Oyarzabal Irigoyen, M, García Cuartero, B, Barrio Castellanos, R, Torres Lacruz, M, Gómez Gila, A L, González Casado, I, Hermoso López, F, Luzuriaga Tomás, C, Rica Etxebarrial, I, López García, M J, Rodríguez Rigual, M
• Format: Journal Article
• Language: English
• Published: Israel 01-03-2012
• Subjects: Age Distribution; Age of Onset; Child; Child, Preschool; Diabetes Mellitus, Type 1 - epidemiology; Diabetic Ketoacidosis - epidemiology; Humans; Incidence; Infant; Retrospective Studies; Risk Factors; Spain - epidemiology; Spain
• ISSN: 1565-4753

DKA at diagnosis of T1DM is a life-threatening situation that represents the main cause of morbidity and mortality in pediatric patients with T1DM.
To determine whether the occurrence and severity of DKA at diagnosis of T1DM has suffered any changes in recent years in the Spanish paediatric population.
Data from 1169 patients with T1DM under 15 years of age was retrospectively studied (2004 -2008) for the presence and severity of DKA at the onset of T1DM, and compared to previous available studies in Spain. This study is multicentric, nationwide with eleven major Paediatric Diabetes Units involved.
Complete data were available from 1151 patients (98%). Frequency of DKA was 39.5%, which is not significantly different from previous Spanish studies. 33.8%, children of 0-4.9 years of age, 40.8% aged 5-10.9 and 25.2% aged 11-14.9 years. Mean age of patients with DKA was significantly lower than the one of patients without DKA (7.44 +/- 4.10 versus 8.47 +/- 3.63 years). Mild DKA was occurring more frequently than moderate and severe forms (47.8%, versus 34.4% versus 17.8%, p<0.0001). Incidence of severe DKA was significantly higher in children under 4.9 years of age, especially in those younger than 2 years (p<0.001). Severe DKA led to complications in three children (cerebral oedema [n=1]), cerebral infarction (n=1) and femoral vein thrombosis (n=1).
Frequency of DKA at diagnosis of T1DM in Spain is still high although most cases were mild. Children under 2 years of age seem to be at increased risk for severe DKA.