Journal Article

770 Does diabetic ketoacidosis at diagnosis of Type 1 Diabetes in children affect long term glycaemic control?

Rowley, Annabel, Sachdev, Pooja

2023

Overview

ObjectivesAttaining optimal glycaemic control in paediatric patients with T1DM is challenging, with reports that only 11.8% of paediatric patients achieve a target HbA1c (<48mmol/mol) (Anon., 2022). It is well established that good glycaemic control is key to reducing long-term diabetic complications, and is the underlying principle of diabetic management.2 Paediatric patients most commonly present in two different ways at diagnosis- osmotic symptoms without diabetic ketoacidosis (DKA) or in DKA. Previous studies have reported that DKA at diagnosis is a predictor of poorer long-term glycaemic control irrespective of demographics and socio-economic factors.3, 4The aims of this project were to explore whether there was an association betweenPresenting HbA1c in patients with DKA compared with patients who did not present in DKAMode of presentation and long-term glycaemic control (using HbA1c values)MethodsData was collected from 114 paediatric patients diagnosed with T1DM between January 2015 and March 2019 at Nottingham Children’s Hospital. Final HbA1c was regarded as the 6-month average of HbA1c values last recorded, before March 2020 (pre-pandemic). Data was analysed using SPSS software.ResultsThis audit included 114 patients, of which 33 initially presented in DKA. 59.6% of patients were male; mean age at diagnosis was 9.62 years (SD±4.50). There was no significant difference between the final HbA1c value and the DKA status at diagnosis: p=0.166, (independent samples test). There was no difference between the initial HbA1c at presentation in the DKA patients compared with the patients not in DKA (p=0.072) (figure 1). Age, duration of diabetes, gender and length of preceding symptoms before diagnosis of T1DM also did not show a difference between the DKA at presentation versus non-DKA at presentation group. However DKA patients diagnosed with T1DM were significantly younger at diagnosis than those that did not present initially in DKA (p=0.041) (table 1).Abstract 770 Figure 1Initial HbA1c compared with DKA status of the patient at presentation (non-significant result)[Figure omitted. See PDF]ConclusionOur results did not show any statistically significant difference between DKA status at presentation and glycaemic control between 1–5 years later, which contrasts with other studies. This mirrors the findings from a similar audit from our centre in 2007. Other significant factors, which influence glycaemic control in the paediatric population, include family support, socioeconomic status, pubertal status, ethnicity and access to technology.5–7 Comprehensive research into these factors is required as well as greater effort to implement evidence-based, targeted screening programs and psychosocial interventions to reduce the incidence of DKA at presentation and improve long-term glycaemic control.ReferencesAnon., 2022. National Paediatric Diabetes Audit Annual Report 2020–21: Care Processes and Outcomes. Royal College of Paediatrics and Child Health.Watts WH. Lamabadusuriya, and J Edge. Targeting glycaemic control in children and young people with type 1 diabetes: Getting it right from day one. Diabetes Care for Children & Young People 2014;3(3):89–95.Duca LM, et al. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 2017;40(9):1249–1255.Shalitin S, et al. Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control. Pediatr Diabetes 2018;19(2):320–328.Sherwood Z. What factors influence glycaemic control in children aged under 11 years with type 1 diabetes? A literature review. Journal of Diabetes Nursing 2016;20:213–7.Viklund G, Örtqvist E. Factors predicting glycaemic control in young persons with type 1 diabetes. International Diabetes Nursing 2014;11(3):75–78.Mazarello Paes V, et al. Factors predicting poor glycemic control in first two years of childhood onset type 1 diabetes in a cohort from East London, UK: Analyses using mixed effects fractional polynomial models. Pediatr Diabetes 2020;21(2):288–299.

• Publisher: BMJ Publishing Group LTD
• Subject: Annual Reports / Child Health / Children / Diabetes / Diabetes mellitus (insulin dependent) / Diabetic ketoacidosis / Diagnosis / Economic factors / Family Involvement / Ketoacidosis / Literature reviews / Medical diagnosis / Nursing / Patients / Pediatrics / Socioeconomic factors / Socioeconomic Status / Socioeconomics / Statistical analysis / Young Adults