Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait

Abstract

We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0-14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1(st) January 2011 and 31(st) December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2-14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27-0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait.

Figure 1. Flowchart demonstrating the exclusion criteria used to derive the final data set on children presented with DKA at the onset of T1DM.

Figure 2. Extent of DKA severity in children from three different age groups.

Figure 3. Percentage of T1DM children with DKA according to age at diagnosis of T1DM (Black bars on left Y-axis).

Total number of new T1DM children in Kuwait from 2011–2013 (Blue circles on right Y-axis).

Figure 4. Observed year-wise extent of DKA Severity in children diagnosed for T1DM during the years 2011 to 2013.