Incidence of Type 1 diabetes and factors associated with presence and severity of ketoacidosis at onset in children

Main Article Content

Stefano Tumini
Salwa Baki
Ioanna Kosteria
Italo Di Giuseppe
Gabriella Levantini

Keywords

Diabetic Ketoacidosis – Diabetes Mellitus, Type 1 – Incidence – Child – Delivery of Health Care

Abstract

Background and aim: To assess the incidence of Type 1 Diabetes Mellitus (T1DM) during the period 2012-2017, the frequency and severity of ketoacidosis (DKA) at diabetes onset, and the factors associated with DKA in children and adolescents younger than 18 years old in the Abruzzo region, Italy.


Methods: All incident cases of T1DM (0-17 years old) diagnosed between January 2012 and December 2017 were included. Data about the patients were obtained from two independent sources; insulin prescriptions and medical records. Clinical data at diabetes onset, as well as demographic and non-demographic data, including center of first hospitalization, distance to regional reference center and number of pediatricians (per 1000 residents younger than 18 years) were collected and evaluated.


Results: During 2012-2017 period, 177 patients were diagnosed with T1DM. In 2012, T1DM incidence was 15.6 per 100,000/year; in 2013, 16.4 per 100,000/year; in 2014, 11.6 per 100,000/year; in 2015, 14.2 per 100,000/year; in 2016, 16.2 per 100,000/year and in 2017, 12.2 per 100,000/year. DKA was present in 29.3% of patients, 6.9% with severe DKA. The DKA presence was correlated to age (p<0.02), ethnicity (p<0.04), being transferred to a specialist center instead of being directly admitted to one (p<0.002) and the number of pediatricians in the population (p<0.01). The DKA severity was associated with the delay of transfer (p<0.04).


Conclusions: Being admitted directly to a specialist center is very important and it could be expression of high alertness of pediatricians. Availability of well-trained pediatricians is necessary for the prevention of DKA. (www.actabiomedica.it)

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References

1. Atkilt HS, Turago MG, Tegegne BS. Clinical Characteristics of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in Addis Ababa, Ethiopia: A Cross-Sectional Study. PLoS One. 2017;12(1):e0169666.
2. Mayer-Davis EJ, Kahkoska AR, Jefferies C, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19 (Suppl. 27): 7–19.
3. Harjutsalo V, Sund R, Knip M, Groop PH. Incidence of Type 1 Diabetes in Finland. JAMA. 2013;310(4):427–428.
4. Skrivarhaug T, Stene LC, Drivvoll AK, Strøm H, Joner G, Group NCDS. Incidence of type 1 diabetes in Norway among children aged 0–14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry. Diabetologia. 2014;57(1):57–62.
5. Patterson CC, Harjutsalo V, Rosenbauer J, et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013: a multicentre prospective registration study. Diabetologia. 2019;62(3):408–17.
6. Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes. 2014;5(6):932–8.
7. Ghetti S, Lee JK, Sims CE, Demaster DM, Glaser NS. Diabetic ketoacidosis and memory dysfunction in children with type 1 diabetes. J Pediatr. 2010;156(1):109–14.
8. Aye T, Mazaika PK, Mauras N, et al. Impact of early diabetic ketoacidosis on the developing brain. Diabetes Care. 2019;42(3):443–9.
9. Hamed SA. Brain injury with diabetes mellitus: evidence, mechanisms and treatment implications. Expert Rev Clin Pharmacol. 2017;10(4):409–28.
10. 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.
11. Große J, Hornstein H, Manuwald U, Kugler J, Glauche I, Rothe U. Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index (HDI): An Updated Systematic Review, Meta-Analysis, and Meta-Regression. Horm Metab Res. 2018;50(03):209–22.
12. Jefferies C, Cutfield SW, Derraik JGB, 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.
13. 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 May;133(4):e938-45.
14. 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.
15. Gunn ER, Albert BB, Hofman PL, Cutfield WS, Gunn AJ, Jefferies CA. Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: Evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014. Pediatr Diabetes. 2017;18(7):553–8.
16. Lee HJ, Yu HW, Jung HW, et al. Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents. @BULLET J Korean Med Sci. 2017;32(2):303–9.
17. Nakhla M, Rahme E, Simard M, Larocque I, Legault L, Li P. Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: A population-based retrospective cohort study. Cmaj. 2018;190(14):E416–21.
18. Baldelli L, Flitter B, Pyle L, et al. A survey of youth with new onset type 1 diabetes: Opportunities to reduce diabetic ketoacidosis. Pediatr Diabetes. 2017;18(7):547–52.
19. Małachowska B, Małachowska K, Pietrzyk J, Fendler W, Rzeznik D, Mlynarski W. Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children. J Pediatr Endocrinol Metab. 2014;27(11–12):1137–43.
20. Fritsch M, Schober E, Rami-Merhar B, Hofer S, Fröhlich-Reiterer E, Waldhoer T. Diabetic ketoacidosis at diagnosis in Austrian children: a population-based analysis, 1989-2011. J Pediatr. 2013;163(5):1484-8.e1.
21. Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care. 1999;22(1):7–9.
22. Vanelli M, Chiari G, Lacava S, Iovane B. Campaign for diabetic ketoacidosis prevention still effective 8 years later. Diabetes Care. 2007;30(4)e12.
23. Choleau C, Maitre J, Elie C, et al. Effet à un an de la campagne nationale de prévention de l’acidocétose au moment du diagnostic de diabète de type 1 chez l’enfant et l’adolescent. Arch Pédiatrie. 2014;1–9.
24. 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.
25. Bruno G, Maule M, Merletti F, et al. Age-period-cohort analysis of 1990-2003 incidence time trends of childhood diabetes in Italy: the RIDI study. Diabetes. 2010;59(9):2281–7.
26. Marigliano M, Tadiotto E, Morandi A, et al. Epidemiology of Type 1 Diabetes Mellitus in the pediatric population in Veneto Region, Italy. Diabetes Res Clin Pract. 2015;107(3):e19–21.
27. Altobelli E, Chiarelli F, Valenti M, Verrotti A, Tumini S, Di Orio F. Incidence of insulin-dependent diabetes mellitus (0-14 years) in the Abruzzo Region, Italy, 1990-1995: results from a population-based register. J Pediatr Endocrinol Metab. 1998;11(4):555–62.
28. Wolfsdorf J, Craig ME, Daneman D, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes. 2009;10:118–33.
29. Laporte RE, Mccarty D, Bruno G, Tajima N, Baba S. Counting diabetes in the next millennium: Application of capture-recapture technology. Diabetes Care. 1993;16(2):528–34.
30. Patterson CC, Gyürüs E, Rosenbauer J, et al. Trends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of non-uniformity over time in rates of increase. Diabetologia. 2012;55(8):2142–7.
31. Vukovic R, Jesic MD, Vorgucin I, et al. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study. Eur J Pediatr. 2018;177(8):1155–62.
32. Carle F, Gesuita R, Bruno G, et al. Diabetes Incidence in 0-to 14-Year Age-Group in Italy A 10-year prospective study FOR THE RIDI STUDY GROUP*. Diabetes Care. 2004;27(12):2790–6.
33. Fortunato F, Cappelli MG, Vece MM, et al. Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry. J Diabetes Res. 2016;2016:1–7.
34. Fox DA, Islam N, Sutherland J, Reimer K, Amed S. Type 1 diabetes incidence and prevalence trends in a cohort of Canadian children and youth. Pediatr Diabetes. 2018;19:501–505.
35. Gerasimidi Vazeou A, Kordonouri O, Witsch M, et al. Seasonality at the clinical onset of type 1 diabetes-Lessons from the SWEET database. Pediatr Diabetes. 2016;17:32–7.
36. Zucchini S, Scaramuzza AE, Bonfanti R, et al. A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes. J Diabetes Res. 2016;2016:1–6.
37. Salardi S, Porta M, Maltoni G, et al. Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20years later. J Diabetes Complications. 2016;30(1):55–60.
38. Szypowska A, Ramotowska A, Grzechnik-Gryziak M, Szypowski W, Pasierb A, Piechowiak K. High frequency of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. J Diabetes Res. 2016;2016:1–5.
39. Szypowska A, Skórka A. The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes. 2011;12(14):302–6.
40. Eyal O, Oren A, Almasi-Wolker D, Tenenbaum-Rakover Y, Rachmiel M, Weintrob N. Ketoacidosis in newly diagnosed type 1 diabetes in children and adolescents in israel: Prevalence and risk factors. Isr Med Assoc J. 2018;20(2):100–3.
41. Mallare JT, Cordice CC, Ryan BA, Carey DE, Kreitzer PM, Frank GR. Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus. Clin Pediatr (Phila). 2003;42(7):591–7.
42. PawÅowicz M, Birkholz D, NiedÅwiecki M, Balcerska A. Difficulties or mistakes in diagnosing type 1 diabetes in children? - demographic factors influencing delayed diagnosis. Pediatr Diabetes. 2009;10(8):542–9.
43. Bui H, To T, Stein R, Fung K, Daneman D. Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr. 2010;156(3):472–7.
44. Lokulo-Sodipe K, Moon RJ, Edge JA, Davies JH. Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK. Arch Dis Child. 2014;99(5):438–42.
45. Townson J, Cannings‐John R, Francis N, Thayer D, Gregory JW. Presentation to primary care during the prodrome of type 1 diabetes in childhood: A case‐control study using record data linkage. Pediatr Diabetes. 2019;20(3):330–8.
46. Nagl K, Rosenbauer J, Neu A, et al. Children with onset-ketoacidosis are admitted to the nearest hospital available, regardless of center size. J Pediatr Endocrinol Metab. 2020;33(6):751-759.
47. Williamson S. The best model of care for children and young people with diabetes. J R Coll Physicians Edinb. 2010;40(Suppl 17):25–32.