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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Cohen, Pinhas / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Feihong / Mericq, Veronica / Roth, Christian / Toppari, Jorma

Editorial Board Member: Battelino, Tadej / Buyukgebiz, Atilla / Cassorla, Fernando / Chrousos, George P. / Cutfield, Wayne / Fideleff, Hugo L. / Hershkovitz, Eli / Hiort, Olaf / LaFranchi, Stephen H. / Lanes M. D., Roberto / Mohn, Angelika / Root, Allen W. / Rosenfeld, Ron G. / Werther, George / Zadik, Zvi

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IMPACT FACTOR 2016: 1.233

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2191-0251
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Volume 26, Issue 11-12 (Nov 2013)

Issues

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

Ahmet Uçar
  • Corresponding author
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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/ Nurçin Saka
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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/ Firdevs Baş
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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  • De Gruyter OnlineGoogle Scholar
/ Mine Sukur
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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  • De Gruyter OnlineGoogle Scholar
/ Sukran Poyrazoğlu
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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  • De Gruyter OnlineGoogle Scholar
/ Feyza Darendeliler
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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  • De Gruyter OnlineGoogle Scholar
/ Ruveyde Bundak
  • Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Centre, Istanbul University, Istanbul, Turkey
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Published Online: 2013-06-08 | DOI: https://doi.org/10.1515/jpem-2013-0060

Abstract

Aims: To assess the frequency and severity of diabetic ketoacidosis (DKA) at disease onset in children newly diagnosed with autoimmune type 1 diabetes (T1D) in Istanbul in the last decade. Also, to evaluate the potential contribution of the national diabetes awareness programme (NDAP) initiated in 2010.

Methods: Four hundred and one consecutive children (mean±standard deviation, age 8.1±4.1 years) with a diagnosis of autoimmune T1D were evaluated retrospectively with respect to demographic, clinical, and laboratory data in relation to DKA at disease onset. The possible impact of NDAP on the rate of DKA at disease onset in the last 2 years was also evaluated by comparing the data related to the time intervals before and after the onset of the programme. The results were evaluated at 95% confidence interval and significance was granted for p≤0.05.

Results: The overall frequency of DKA at disease onset was 44.2%, with a significant trend for decline in rate of DKA at disease onset in the last decade (p=0.0001). There were no significant differences in proportions of newly diagnosed T1D patients with severe or moderate DKA over time. Mean body mass index standard deviation score tended to increase in the last decade, but not significantly (p=0.09). When the time intervals before and after the onset of NDAP were evaluated, there was a more than two-fold decrease in rate of DKA (from 49.3% to 23.9%) (p<0.0001).

Conclusions: The frequency of a DKA event at onset of T1D is still high in Istanbul children despite a decreasing trend in the last decade. NDAP may significantly contribute to the reduction in rate of DKA.

Keywords: decade; diabetes; diabetes awareness programme; frequency; ketoacidosis

References

  • 1.

    Wolsdorf J, Craig ME, Daneman D, Dunger D, Edge J, et al. ISPAD clinical practice guidelines compendium. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 2009;10:118–23.CrossrefWeb of ScienceGoogle Scholar

  • 2.

    Hekkala A, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 diabetes in children in Northern Finland. Temporal changes over 20 years. Diabetes Care 2007;30:861–6.Google Scholar

  • 3.

    Abdul-Rasoul M, Al-Mahdi M, Al-Qattan H, Al-Tarkatit N, Alkhouly M, et al. Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics. Pediatr Diabetes 2010;11:351–6.Web of ScienceGoogle Scholar

  • 4.

    Neu A, Hofer ES, Karges B, Oeverink R, Rosenbauer J, et al. Ketoacidosis at diabetes onset is still frequent in children and adolescents: a multicenter analysis of 14,664 patients from 106 institutions. Diabetes Care 2009;32:1647–8.Web of ScienceGoogle Scholar

  • 5.

    Bui TP, Werther GA, Cameron FJ. Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience. Pediatr Diabetes 2002;3:82–8.PubMedCrossrefGoogle Scholar

  • 6.

    Schober E, Waldhoer T, Rami B, Hofer S, Austrian Diabetes Incidence Study Group. Incidence and time trend of type 1 and type 2 diabetes in Austrian children 1999–2007. J Pediatr 2009;155:190–3.e1.Google Scholar

  • 7.

    Lévy-Marchal C, Patterson CC, Green A, EURODIAB ACE Study Group. Geographical variation of presentation at diagnosis of type 1 diabetes in children: the EURODIAB study. European and dibetes. Diabetologia 2001;44(Suppl 3):B75–80.CrossrefGoogle Scholar

  • 8.

    Sadauskaite-Kuehne V, Samuelsson U, Jasinskiene E, Padagia Z, Urbonaite B, et al. Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition. Diabetes Res Clin Pract 2002;55:247–54.CrossrefGoogle Scholar

  • 9.

    Akesen E, Turan S, Guran T, Atay Z, Save D, et al. Prevalence of type 1 diabetes mellitus in 6–18-yr-old school children living in Istanbul, Turkey. Pediatr Diabetes 2011;12: 567–71.Google Scholar

  • 10.

    Hatun Ş. Diabetes program at schools in Turkey. J Clin Res Pediatr Endocrinol 2012;4:114–5.CrossrefPubMedGoogle Scholar

  • 11.

    Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Akın M, Çoban D, et al. Body weight, length and head circumference at birth in a cohort of Turkish newborns. J Clin Res Pediatr Endocrinol 2012;4:132–9.CrossrefGoogle Scholar

  • 12.

    Tanner JM. Recording adolescent physical changes. Tanner System Del Med J 1973;45:84–8.Google Scholar

  • 13.

    Neyzi O, Furman A, Bundak R, Gunoz H, Darendeliler F, et al. Growth references for Turkish children aged 6–18 years. Acta Paediatr 2006;95:1635–41.Web of ScienceCrossrefGoogle Scholar

  • 14.

    Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, et al. Body mass index references for Turkish children. Acta Padiatr 2006;95:194–8.CrossrefGoogle Scholar

  • 15.

    The Diabetes Control and Complications Trial Research Group. Effect of age, duration and treatment of insulin-dependent diabetes mellitus on residual beta-cell function: observations during eligibility testing for the Diabetes Control and Complications Trial (DCCT). J Clin Endocrinol Metab 1987;65:30–6.Google Scholar

  • 16.

    Effect of intensive therapy on residual beta-cell function in patients with type 1 diabetes in the diabetes control and complications trial. A randomized, controlled trial. The Diabetes Control and Complications Trial Research Group. Ann Intern Med 1998;128:517–23.Google Scholar

  • 17.

    Vanelli M, Chiari G, Costi G, Ghizzoni L, Giacalone T, et al. Effectiveness of a prevention program for diabetic ketoacidosis in children. Diabetes Care 1999;22:7–9.CrossrefPubMedGoogle Scholar

  • 18.

    Knip M, Reunanen A, Virtanen SM, Nuutinen M, Viikari J, et al. Does the secular increase in body mass in children contribute to the increasing incidence of type 1 diabetes? Pediatr Diabetes 2008;9:46–9.Web of ScienceGoogle Scholar

  • 19.

    Merger SR, Leslie RD, Boehm BO. The broad clinical phenotype of type 1 diabetes at presentation. Diabet Med 2013;30:170–8.CrossrefPubMedGoogle Scholar

  • 20.

    Böber E, Dündar B, Büyükgebiz A. Partial remission phase and metabolic control in type 1 diabetes mellitus in children and adolescents. J Pediatr Endocrinol Metab 2001;14:435–41.PubMedGoogle Scholar

  • 21.

    Komulainen J, Lounamaa R, Knip M, Kaprio EA, Akerblom HK. Ketoacidosis at diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group. Arch Dis Child 1996;75:410–5.CrossrefGoogle Scholar

  • 22.

    Ludvigsson J, Faresjö M, Hjorth M, Axelsson S, Cheramy M, et al. GAD treatment and insulin secretion in recent-onset type 1 diabetes. N Engl J Med 2008;359:1909–20.Web of ScienceGoogle Scholar

  • 23.

    Mortensen HB, Swift GF, Holl RW, Hougaard P, Hansen L, et al. Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis. Pediatric Diabetes 2010;11:218–26.PubMedWeb of ScienceGoogle Scholar

  • 24.

    Al Alwan I, Bin Dajim N, Jawdat D, Tamimi W, Al Ahmdi R, et al. Prevalence of autoantibodies in children newly diagnosed with type 1 diabetes mellitus. Br J Biomed Sci 2012;69:31–3.PubMedGoogle Scholar

  • 25.

    Lo FS, Yang MH, Chang LY, Ou YC, Van YH. Clinical features of type 1 diabetic children at initial diagnosis. Acta Paediatrica Taiwanica 2004;45:218–23.Google Scholar

  • 26.

    Szypowska A, Skorka A. The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes 2011;12:302–6.CrossrefPubMedGoogle Scholar

  • 27.

    Amos AF, McCarty DJ, Zimmer P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997;14(Suppl 5):S1–85.Google Scholar

  • 28.

    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.Web of ScienceGoogle Scholar

  • 29.

    de Vries L, Oren L, Yebenthal Y, Shalitin S, Lazar L, et al. Decrease in frequency of ketoacidosis at diabetes onset over the past two decades – perspectives of a paediatric tertiary care centre. Diabet Med 2012;29:e170–5.Google Scholar

About the article

Corresponding author: Ahmet Uçar, PhD, Istanbul Medical Faculty, Paediatric Endocrinology and Diabetes Unit, Istanbul University, Çapa, Istanbul, Turkey, Phone: +90-2124142000-31645, Fax: +90-2125338333, E-mail: ;


Received: 2013-02-12

Accepted: 2013-05-14

Published Online: 2013-06-08

Published in Print: 2013-11-01


Citation Information: Journal of Pediatric Endocrinology and Metabolism, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2013-0060.

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