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. 2022 Aug 24;35(9):1132-1140.
doi: 10.1515/jpem-2022-0255. Print 2022 Sep 27.

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

Sarah Wing-Yiu Poon  1 , Joanna Yuet-Ling Tung  2 , Wilfred Hing-Sang Wong  1 , Pik-To Cheung  1 , Antony Chun-Cheung Fu  3 , Gloria Shir-Wey Pang  2   3 , Sharon Wing-Yan To  3 , Lap-Ming Wong  4 , Wai-Yu Wong  4 , Suk-Yan Chan  5 , Ho-Chung Yau  5 , Wing-Shan See  1 , Betty Wai-Man But  6 , Shirley Man-Yee Wong  6 , Priscilla Wai-Chee Lo  7 , Kwok-Leung Ng  7 , Kwong-Tat Chan  8 , Hi-Yuet Lam  9 , Sammy Wai-Chun Wong  9 , Yuen-Yu Lam  10 , Hoi-Wing Yuen  10 , Jacky Ying-Ki Chung  11 , Ching-Yee Lee  11 , Ming-Kut Tay  12 , Elaine Yin-Wah Kwan  8
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Free article

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

Sarah Wing-Yiu Poon et al. J Pediatr Endocrinol Metab. .
Free article

Abstract

Objectives: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). The aim of this study is to analyze the incidence, clinical characteristics, management and outcome of children presenting with DKA in new-onset T1D from 2008 to 2018 in Hong Kong.

Methods: Data was extracted from the Hong Kong Childhood Diabetes Registry. All subjects less than 18 years with newly diagnosed T1D from 1 January 2008 to 31 December 2018 managed in the public hospitals were included. Information on demographics, laboratory parameters, DKA-related complications and management were analyzed.

Results: 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 ± 5.9 days vs. 10.6 ± 17.1 days, p<0.01). Regarding management, up to 12.4% were given insulin boluses and 82.6% were started on insulin infusion 1 h after fluid resuscitation. The rate of cerebral edema was 0.8% and there was no mortality.

Conclusions: 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.

Keywords: Hong Kong; diabetic ketoacidosis; pediatrics; risk factors; type 1 diabetes mellitus.

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