Diabetic ketoacidosis in children with new-onset type 1 diabetes mellitus: demographics, risk factors and outcome: an 11year review in Hong Kong.

Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). The aim of this study isto analyze the incidence, clinical characteristics, management and outcome of children presenting with DKA in new-onset T1D from 2008 to 2018 in Hong Kong. Data was extracted from the Hong Kong Childhood Diabetes Registry. All subjects less than 18years with newly diagnosed T1D from 1 January 2008 to31 December 2018 managed in the public hospitals wereincluded. Information on demographics, laboratory parameters, DKA-related complications and management were analyzed. In the study period, there were 556 children with newly diagnosed T1D in our registry and 43.3% presented with DKA. The crude incidence rate of new-onset T1D with DKA was 1.79 per 100,000 persons/year (CI: 1.56-2.04). Subjects presenting with DKA were younger (9.5±4.5 vs. 10.5±4.4, p=0.01) and had shorter duration of symptoms (4.2±5.9days vs. 10.6±17.1days, p<0.01). Regarding management, up to 12.4% were given insulin boluses and 82.6% were started on insulin infusion 1h after fluid resuscitation. The rate of cerebral edema was 0.8% and there was no mortality. Younger age and shorter duration of symptoms were associated with DKA in new-onset T1D. Despite availability of international guidelines, there was inconsistency in acute DKA management. These call for a need to raise public awareness on childhood diabetes as well as standardization of practice in management of pediatric DKA in Hong Kong.