Prevalence Of Diabetic Ketoacidosis Research Articles

Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011-2018) at a tertiary paediatric hospital in Tripoli, Libya.

Diabetic ketoacidosis (DKA) stands as a critical, acute complication of type 1 diabetes. Despite its severity, there exists a dearth of data concerning the frequency and prevalence of DKA at the onset of type 1 diabetes in Libyan children. This study aimed to ascertain the frequency of DKA during the initial presentation of type 1 diabetes among children aged 0.5-14 years admitted to Tripoli Children's Hospital between 2011 and 2018. Employing a retrospective approach, the study examined the proportion of children with newly diagnosed type 1 diabetes who presented with DKA. Data analysis included estimating DKA frequency concerning age at presentation, sex, and age groups. The comparative analysis involved assessing DKA frequency between 0.5 and <2 and 2-14 years age groups. Logistic regression analysis evaluated the impact of age group, sex, and family history of type 1 diabetes on DKA and severe DKA occurrence. Among 497 children with newly diagnosed type 1 diabetes, 39.2 % presented with DKA, of these 44.5 % had severe DKA. Females exhibited a higher DKA rate than males (OR 1.63, 95 % CI 1.13-2.34, p=0.009). Very young children (0.5 to <2 years) presented with DKA more frequently than those aged 2-14 years (OR 4.73, 95 % CI 2.65-8.47, p<0.001), and they were more likely to present in severe DKA (63.9 vs. 39.1 %, [OR 7.26, 95 % CI 3.65-14.41, p<0.001]). The frequency of DKA at type 1 diabetes onset among children admitted to Tripoli Children's Hospital is notably high, with nearly half of the DKA episodes categorized as severe. Very young children notably demonstrated a fivefold increase in the likelihood of presenting with DKA.

Lower Prevalence of Diabetic Ketoacidosis at Diagnosis in Research Participants Monitored for Hyperglycemia.

In Colorado children, the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) has been increasing over time. Evaluate the prevalence of and factors involved in DKA at T1D diagnosis among participants followed in monitoring research studies before diagnosis compared to patients from the community. Patients<18 years diagnosed with T1D between 2005 and 2021 at the Barbara Davis Center for Diabetes. Prevalence of and factors associated with DKA at diagnosis among participants in preclinical monitoring studies compared to those diagnosed in the community. Of 5049 subjects, 164 were active study participants, 42 inactive study participants, and 4843 were community patients. Active study participants, compared to community patients, had lower HbA1c (7.3% vs 11.9%]; P<0.001) and less frequently experienced DKA (4.9% vs 48.5%; P<0.001), including severe DKA (1.2% vs 16.2%; P<0.001). Inactive study participants had intermediate levels for both prevalence and severity of DKA. DKA prevalence increased in community patients, from 44.0% to 55%, with less evidence for a temporal trend in study participants. DKA prevalence was highest in children <2 years (13% in active study participants vs 83% in community patients). In community patients, younger age (P=0.0038), public insurance (P<0.0001), rural residence (P<0.0076), higher HbA1c (P<0.0001), and ethnicity minority status (P<0.0001) were associated with DKA at diagnosis. While DKA prevalence increases in community patients over time, it stayed <5% in active research participants, who have a 10 times lower prevalence of DKA at diagnosis, including in minorities.

Seasonal Variation of Diabetic Ketoacidosis in Nangarhar University Teaching Hospital

Diabetic ketoacidosis is a life threating acute complication of diabetes mellitus aquiring special care. The aim of the study was to find out seasonal variation in the prevalence of diabetic ketoacidosis in diabetic patients. It was a cross sectional hospital based study conducted over both male and female diabetic patients admitter at the internal medicine ward of Nangarhar University Teaching Hospital during one year. Mean age across DKA was 53.9 ± 14 for DKA negative patients versus 51.3 ± 17.2 for DKA positive patients, P value = 0.26. Winter season was demonstrated with peak DKA positive cases 21 (43.7%) followed by fall 6 (22.2%), summer 11 (12.2%) and spring 10 (10.3%), respectively (P value = 0.01). Common associated factors included infection (72.2%), ischemia (8.2%), insulin withdrawal (7.7%), and others (6.9%) though not statistically different across seasons. There was significant seasonal variation in the prevalence of diabetic ketoacidosis denoting winter season with peak diabetic ketoacidosis. In fact, infection followed by ischemia and insulin withdrawal was the leading associated factor contributing to the prevalence of diabetic ketoacidosis. Season specific special attention should be paid the relevant symptoms of diabetic ketoacidosis for the early detection and treatment of the disease in order to avoid morbidity and mortality.

Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

ObjectivesThis systematic review and meta-analysis aimed to assess the magnitude and determinants of diabetic ketoacidosis (DKA) among patients with diabetes mellitus (DM) in Ethiopia.DesignSystematic review and meta-analysis.ParticipantsAge 15 and above...

FRI592 Pediatric Diabetes Mellitus And The COVID-19 Pandemic

Abstract Disclosure: F.I. Cooper: None. A. Thokalath: None. S. Chalise: None. N. Vyas: None. S. Gurnurkar: None. Introduction: Evidence suggests that during the COVID-19 pandemic, adults had delayed detection of diabetes mellitus (DM) and its complications as well as an increase in the severity of DM symptoms. Our retrospective study aimed to determine the difference in prevalence of new onset DM and to compare the severity of diabetic ketoacidosis (DKA) in these children prior to and during the COVID-19 pandemic at Nemours Children’s Health in Orlando, FL. Methods: Chart review was performed on children with new onset DM (type 1 and 2) pre-pandemic and during the pandemic (9/1/2017-9/1/2022). 509 participants met inclusion criteria. Demographic information and laboratory data were collected. One sample proportions test was used to compare the proportion of new onset DM diagnoses and severity of presentation. Chi square test was used to test association of demographics with DM onset and DKA status. Statistical significance was set at p&amp;lt;0.05 and all analyses were run on IBM SPSS 28.0. Results: A greater number of pediatric DM diagnoses were made during the COVID-19 pandemic when compared to pre-pandemic [295 vs 214 (p&amp;lt;0.001)]. More patients presented in DKA at initial diagnosis during the pandemic compared to pre-pandemic (52% vs 48%, p=0.046). There was no significant difference in DKA severity between the pre-pandemic and pandemic groups (p=0.179). There was a significant difference in the average Hemoglobin A1C at diagnosis between COVID-19 unknown and COVID-19 negative group (12% vs. 10.6%, p&amp;lt;0.05). Conclusion: Our study found that more children were diagnosed with DM during the COVID-19 pandemic compared to an equal length of time pre-pandemic. We also found that the prevalence of DKA among those with new-onset DM was higher during the pandemic period. It is speculated that SARS-CoV-2 can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Additional studies are needed to investigate this mechanism specifically among children with new onset DM. Presentation: Friday, June 16, 2023

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

1279-P: The INNODIA Natural History Study of Children, Adolescents, and Adults Newly Diagnosed with Type 1 Diabetes

Using the INNODIA consortium European infrastructure, we aimed to discover novel biomarkers of T1D progression. Here we report clinical and biochemical characteristics of people with new-onset T1D during the first year from diagnosis. Children and adults (age 1-45 yrs) were recruited within 6 weeks from T1D onset in 11 European countries. Baseline clinical characteristics, C-peptide (fasted and mixed meal tolerance test), HbA1c, autoantibodies, and their overtime changes were assessed across 3 age groups: &amp;lt;10, 10-17, ≥18yrs. The study population included 655 individuals (280: &amp;lt;10 yrs; 274: 10-17 yrs; 101: ≥18 yrs): 57% male; age: 12.1±8.4 yrs; 96% were positive for ≥1 autoantibodies. Autoantibody frequency was IAA 77%, GAD 73%, IA-2A 69%, ZnT8A 66%. Diabetic ketoacidosis prevalence was 35%, with the highest rate in the 10-17 yrs group (44%). At baseline, median [IQR] fasting and area-under-the curve (AUC) C-peptide were 242[140-384] and 753[469-1109]pmol/L, with levels increasing with age (p&amp;lt;0.001; Fig). Over time C-peptide remained lower in participants &amp;lt;10yrs but rates of decline were similar between age groups. HbA1c significantly decreased during the first 3 months (p&amp;lt;0.001). In this large cohort with new-onset T1D, we identified age-related differences in clinical and biochemical parameters. Of note, C-peptide was lower in younger children but there was no age effect on its rate of decline. Disclosure M.Marcovecchio: None. C.Mathieu: Advisory Panel; Novo Nordisk A/S, Boehringer Ingelheim Inc., Eli Lilly and Company, Medtronic, Vertex Pharmaceuticals Incorporated, Roche Diabetes Care, Imcyse, Speaker's Bureau; Novo Nordisk A/S, AstraZeneca, Boehringer Ingelheim Inc., Eli Lilly and Company, Medtronic, Vertex Pharmaceuticals Incorporated. Innodia consortium: n/a. C.Delfin: Employee; Novo Nordisk A/S. M.Hulsmans: None. L.Overbergh: None. S.S.Pazmino: None. D.E.Picton: None. N.Steenackers: None. B.Van der schueren: None. A.E.J.Hendriks: Advisory Panel; Alira Health. Funding Innovative Medicines Initiative 2 Joint Undertaking (115797, 945268)

National Trends in Hyperglycemia and Diabetic Ketoacidosis in Children, Adolescents, and Young Adults With Type 1 Diabetes: A Challenge Due to Age or Stage of Development, or Is New Thinking About Service Provision Needed?

Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context. A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018-2019/2020. For each audit year, the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age. In childhood, unreported HbA1c measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA1c for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1-8.4%, 54-68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0-8.4%, 64-68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5-10.3%, 59-89 mmol/mol) and 8.9% (74 mmol/mol) (7.7-10.6%, 61-92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4-9.7%, 57-83 mmol/mol) and 8.2% (66 mmol/mol) (7.3-9.7%, 56-82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals. HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.

Diabetic Ketoacidosis among Diabetic Patients Admitted in the Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Diabetic ketoacidosis is one of the most severe acute complications of diabetes mellitus characterised by hyperglycemia, hyperketonemia, and metabolic acidosis. Prompt diagnosis and treatment of diabetic ketoacidosis can decrease severity, hospital stay, and possible mortality. This study aimed to find out the prevalence of diabetic ketoacidosis among diabetic patients admitted to the department of medicine of a tertiary care centre. This descriptive cross-sectional study was conducted at a tertiary care centre. Data from 1 March 2022 to 1 December 2022 were collected between 1 January 2023 and 1 February 2023 from the hospital records. The ethical approval was taken from the Institutional Review Committee of the same institute (Reference number: 466/2079/80). All the diabetic patients admitted to the Department of Medicine during our study duration were enrolled for the study. Diabetic patients who left against medical advice and those with incomplete data were excluded from the study. Data were collected from the medical record section. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. Among 200 diabetic patients, the prevalence of diabetic ketoacidosis was 7 (3.5%) (3.47-3.53, 95% Confidence Interval) among which 1 (14.29%) patients had type I diabetes mellitus and 6 (85.71%) had type II diabetes mellitus patients and the mean HbA1C level was 9.77%. The prevalence of diabetic ketoacidosis among diabetes mellitus patients admitted to the department of medicine of a tertiary care centre was found to be higher than in other studies done in similar settings. diabetes mellitus; diabetic complications; diabetic ketoacidosis; Nepal.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Diabetes Ketoacidosis Is a Cause of Concern in Sodium-Glucose Co-Transporter-2 Inhibitors Medication

Abstract: Diabetic ketoacidosis (DKA) is a dangerous complication that can afflict persons with Type 1 and Type 2 diabetes and is caused by a lack of glucose utilization and insulin generation. DKA is diagnosed by observing the anion gap values, blood glucose level, pH, serum bicarbonate level, and so on. DKA is associated with an elevated blood glucose of &gt; 250 mg/dl (16.7 mmol/l) and is diagnosed by observing the values of anion gap, blood glucose level, pH, serum bicarbonate level, and so on. It occurs more frequently in type 1 diabetics with low insulin levels. Sodium-glucose Co-transporter-2 (SGLT-2) inhibitors are a novel family of anti-diabetic medications that lower blood glucose levels and produce glucosuria. The US Food and Drug Administration (USFDA) has issued a drug safety warning about the increased risk of DKA when using SGLT-2 inhibitors. Following the USFDA's warning, the European Medicine Agency reported 101 more cases of ketoacidosis caused by SGLT-2 inhibitors in people with Type 2 Diabetes Mellitus (EMA). According to the American Association of Clinical Endocrinologists, all SGLT-2 inhibitors should be stopped 3-4 days before major surgery and 24 hours before elective surgery. This review article focuses on the metabolism of ketone bodies and many pathophysiologic mechanisms of SGLT-2 inhibitors, which lower insulin/glucagon ratios, promote glucagon secretion from alpha cells, and increase ketones levels by stimulating lipolysis and resulting in ketogenesis. The primary goal of this study is to improve our understanding of a significant consequence of DKA caused by sodium-glucose cotransporter-2 inhibitors in patients with Type 1 and Type 2 diabetes. Psychosocial factors linked to diabetic ketoacidosis in adults with type 1 diabetes, as well as the prevalence of DKA in COVID-19 patients, have been linked to higher severity of mortality and duration of stay in these patients, according to recent research.

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

BackgroundAn increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic.MethodsFor this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006–19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker.Findings87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality.InterpretationDuring the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents.FundingGerman Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions.

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group.

BackgroundThere are several observations that the onset of coronavirus 19 (COVID‐19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country‐specific healthcare policies, more national‐level evidence is needed to provide generalizable conclusions.ObjectiveTo compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID‐19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020).MethodsReference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new‐onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily‐reported number of COVID‐19‐related deaths in each region.ResultsWe recorded 3062 cases of new‐onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre‐ and post‐COVID‐19 period, we observed a significant increase in the rate of DKA (37.5%–49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID‐19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080).ConclusionsThe clinical picture of new‐onset children T1D in Poland deteriorated over a 2‐year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID‐19 epidemic.

Clinical Characteristics, Glycemic Control, and Microvascular Complications Compared Between Young-Onset Type 1 and Type 2 Diabetes Patients at Siriraj Hospital - A Tertiary Referral Center.

PurposeThis study aimed to investigate the clinical characteristics, glycemic control, and microvascular complications compared between young-onset type 1 (T1DM) and type 2 diabetes (T2DM) patients at Siriraj Hospital.Patients and MethodsWe collected demographic, clinical, glycemic control, and microvascular complication data of young-onset (onset <30 years of age) T1DM and T2DM patients at our center using February 2019-December 2020 data from the Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN).ResultsOf 396 patients, 76% had T1DM and 24% had T2DM. At diagnosis, T1DM were significantly younger (9.7±5.4 vs 16.9±6.4 years, p<0.001), had a lower body mass index (17.2±4.1 vs 30.8±7.9 kg/m2, p<0.001), higher prevalence of diabetic ketoacidosis (DKA) (66.1% vs 13.7%, p<0.001), and higher HbA1c level (12.8±2.6% vs 10.9±3.1%, p=0.002) compared to T2DM. Regarding glycemic control, the mean HbA1c at registry enrollment did not differ between groups (T1DM 8.3±1.8% vs T2DM 8.1±2.2%, p=0.303), but T1DM achieved HbA1c <7% significantly less than T2DM (19.3% vs 47.8%, p<0.001). T1DM showed deterioration of glycemic control during 10–20 years of age, and gradually improved during 20–30 years of age, whereas patients with T2DM showed progressive worsening of glycemic control over time. Concerning microvascular complications, the prevalence of diabetic retinopathy (10.6% vs 9%, p=0.92) and diabetic neuropathy (3.4% vs 5.5%, p=0.514) between T1DM and T2DM was not significantly different. However, T2DM had a significantly higher prevalence of diabetic nephropathy (T1DM 10.1% vs T2DM 40.2%, p<0.001) that developed within a significantly shorter duration of diabetes (T1DM 11.0±6.8 vs T2DM 4.3±5.1 years, p<0.001) compared to T1DM.ConclusionT1DM had a significantly high prevalence of DKA at presentation, and most T1DM did not achieve the glycemic target, especially during adolescence. T2DM had a significantly higher prevalence of diabetic nephropathy that developed within a shorter duration of diabetes compared to T1DM.

Moderate and severe diabetic ketoacidosis at type 1 diabetes onset in children over two decades: A population-based study of prevalence and long-term glycemic outcomes.

To investigate in a population-based pediatric cohort: prevalence of moderate-severe diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis over two decades and its association with long-term glycemic control. Children <16 years diagnosed with T1D in Western Australia 2000-2019 were included and followed up for ≤14 years. Moderate-severe DKA at diagnosis was defined as serum pH < 7.2 or bicarbonate<10 mmol/L with hyperglycemia and ketosis. HbA1c was measured ~3-monthly. Trend in prevalence of moderate-severe DKA at diagnosis was investigated using a logistic regression model adjusting for sex, age, socioeconomic status, and area of residence. Long-term glycemic control associated with DKA at diagnosis was investigated using linear mixed models adjusting for the same variables and also for visit frequency, CGM and pump use. Moderate-severe DKA occurred in 534 of 2111 (25.3%) participants. Odds of presenting with moderate-severe DKA increased by 4.1% (95% CI: 2.3, 5.9; p< 0.001) per year. Patients with moderate-severe DKA at diagnosis had higher HbA1c levels than other patients initially; the groups were similar between 2 and 6 years duration; from 7 years HbA1c levels tracked higher in the group with moderate-severe DKA at diagnosis with significant differences at 8 and 12 years (p< 0.05). The increasing prevalence of DKA at diagnosis of pediatric T1D is concerning and highlights the need for early detection programs. Unlike a similar US study, this study did not find a consistent, clinically significant relationship between DKA at diagnosis and long-term HbA1c, raising important questions about the influence of other factors on long-term glycemic outcomes.

Insulin Pump-related Inpatient Admissions in a National Sample of Youth With Type 1 Diabetes.

Insulin pump use in type 1 diabetes management has significantly increased in recent years, but we have few data on its impact on inpatient admissions for acute diabetes complications. We used the 2006, 2009, 2012, and 2019 Kids' Inpatient Database to identify all-cause type 1 diabetes hospital admissions in those with and without documented insulin pump use and insulin pump failure. We described differences in (1) prevalence of acute diabetes complications, (2) severity of illness during hospitalization and disposition after discharge, and (3) length of stay (LOS) and inpatient costs. We identified 228 474 all-cause admissions. Insulin pump use was documented in 7% of admissions, of which 20% were due to pump failure. The prevalence of diabetic ketoacidosis (DKA) was 47% in pump nonusers, 39% in pump users, and 60% in those with pump failure. Admissions for hyperglycemia without DKA, hypoglycemia, sepsis, and soft tissue infections were rare and similar across all groups. Admissions with pump failure had a higher proportion of admissions classified as major severity of illness (14.7%) but had the lowest LOS (1.60 days, 95% CI 1.55-1.65) and healthcare costs ($13 078, 95% CI $12 549-$13 608). Despite the increased prevalence of insulin pump in the United States, a minority of pediatric admissions documented insulin pump use, which may represent undercoding. DKA admission rates were lower among insulin pump users compared to pump nonusers. Improved accuracy in coding practices and other approaches to identify insulin pump users in administrative data are needed, as are interventions to mitigate risk for DKA.

The impact of COVID-19 on Diabetic Ketoacidosis patients

Background and aimDescribe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March–April 2019) and pandemic (March–April 2020) periods. MethodsRetrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3). ResultsDemographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66–3.68) vs. pre-pandemic period (0.72%, 0.54–0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4–54.3) vs. pre-pandemic period (18%, 8.6–31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0–4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2–6.3) and BHBA by 2.1 mmol/L (1.2–3.1) (p < 0.001). ConclusionsCOVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.

Screening of Islet Autoantibodies for Children in the General Population: A Position Statement Endorsed by the European Society for Paediatric Endocrinology.

Type 1 diabetes (T1D) is the most frequent chronic autoimmune disease in childhood and adolescence, its incidence is increasing particularly in toddlers and preschool children, and up to 60% of young patients present with diabetic ketoacidosis (DKA), a severe and life-threatening complication. So far, the majority of screening efforts have been performed in the at-risk group, i.e., relatives of people with T1D; anyhow, around 90% of young patients who eventually develop T1D do not have a family history. Some studies in Europe and the USA have clearly shown that a public health screening of children (with positive autoantibodies) is effective in reducing the prevalence of DKA by more than 10 times, decreasing the rate of hospitalization and its costs, providing psychological, emotional, and social support to children and their families. In addition, several treatments and trials are available for children with stage 2 and stage 3 T1D. There is still room for improvement of sensitivity, specificity, positive and negative predictive value in a population screening program; anyhow, there is vivid debate on the opportunity for a screening program in the general population of children at risk for developing T1D. This paper, endorsed by the European Society for Paediatric Endocrinology (ESPE), discusses the issues of a screening program in the general population with the hope that uncertainties and difficulties in this field will be overcome by better screening methods, improved cost-effectiveness, reliable treatments for secondary prevention, and relevant delay in clinically evident T1D in children and adolescents.

Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic

Introduction: The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear. Methods: A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the COVID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center. Results: Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic. Conclusions: During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.