Diabetic ketoacidosis at the onset of Type 1 diabetes in young children Is it time to launch a tailored campaign for DKA prevention in children <5 years?

Acta Biomed. 2018 Jan 8;89(1):67-71. doi: 10.23750/abm.v89i1.6936.

Abstract

Aim: To analyze clinical characteristics associated with the occurrence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) in children aged <5 years in order to identify early signs or symptoms useful to prevent DKA appearance.

Methods: Data of patients with newly diagnosed TID aged <5 years (Group 1) and 6-10 years old (Group 2) coming from the province of Parma were collected in the period 2012-2016.

Results: Mild/moderate ketoacidosis at diabetes diagnosis occurred more frequently in Group 1 than in Group 2 patients (p<0.0015). Severe DKA incidence was higher in children below 5 (21.8%) than in those over 5 years of age (3.75%; p=0.021). Latent period before overt T1D diagnosis was longer in Group 1 than in Group 2 patients (p=0.0081). During this latent period similar indicators were recorded among parents of children <3 years old: frequent use of disposable baby diapers (87%), wet baby diapers because of a large amount of urine (86%), body weight loss (79%). In children aged 3-4 years reported symptoms consisted of polyuria (89%), polydipsia (79%), fatigue (72%). In Group 2 patients predominant signs concern unusual episodes of enuresis.

Conclusions: We believe that it is time to launch a DKA prevention campaign tailored for children under 5 years old and focused just on the above-mentioned three warning signs. Information program must involves pediatricians, pediatric nurses, new moms and nursery school teachers.

Publication types

  • Comparative Study

MeSH terms

  • 3-Hydroxybutyric Acid / blood
  • Adolescent
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / etiology
  • Diabetic Ketoacidosis / prevention & control*
  • Early Diagnosis
  • Faculty
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Personnel / education
  • Health Promotion / organization & administration*
  • Humans
  • Hydrogen-Ion Concentration
  • Infant
  • Italy / epidemiology
  • Male
  • Parents / education
  • Polydipsia / etiology
  • Polyuria / etiology*
  • Prevalence
  • Retrospective Studies
  • Symptom Assessment
  • Weight Loss

Substances

  • Glycated Hemoglobin A
  • 3-Hydroxybutyric Acid