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
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.
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.
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).
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.
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ABSTRACT: Experimental evidence in animal models suggests that TNF-related apoptosis-inducing ligand (TRAIL), a member of the TNF superfamily, might play an important role in type 1 diabetes (T1D). We have performed a retrospective study by analyzing the sera of a cohort of pediatric subjects (age ≤18 years; n = 507) consisting of (1) patients diagnosed with T1D (n = 387), (2) healthy individuals (n = 98, considered as controls), and (3) healthy autoantibody-positive subjects (n = 22). Patients with T1D exhibited significantly decreased levels of circulating TRAIL with respect to the control healthy subjects, as well as to the healthy autoantibody-positive subjects. Within the T1D group, no differences in the levels of circulating TRAIL were observed between patients with or without other concomitant autoimmune pathologies. Of note, the levels of TRAIL were significantly lower in the T1D patients analyzed at onset, although reduction in TRAIL levels persisted also in patients analyzed after disease onset (>1 year from diagnosis). In particular, T1D patients who exhibited ketoacidosis at onset showed significantly lower levels of circulating TRAIL with respect to patients without ketoacidosis at onset. Moreover, the levels of TRAIL at diagnosis correlated inversely with the insulin requirement up to 21 months of follow-up. This is the first study demonstrating that the levels of circulating TRAIL are significantly decreased in T1D, with the lowest levels of TRAIL being observed in patients with ketoacidosis at the onset and with the highest insulin requirement.Acta Diabetologica 08/2013; 51(2). DOI:10.1007/s00592-013-0507-5 · 2.40 Impact Factor
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ABSTRACT: 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.Journal of pediatric endocrinology & metabolism: JPEM 07/2014; 27(11-12). DOI:10.1515/jpem-2014-0067 · 1.00 Impact Factor