Diabetes Ketoacidosis Recovery in Youth with Newly Diagnosed and Established Type 1 Diabetes
2Sackler Faculty of Medicine, Tel Aviv University
3Department of Pediatrics B, Schneider Children's Medical Center of Israel
Background: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). DKA can occur at diabetes onset and during the course of established diabetes.
Objective: To describe the differences in metabolic parameters and in time to recovery from DKA, between children and adolescents with newly diagnosed compared with established T1DM.
Methods: A single center, retrospective study. The cohort comprised 356 children and adolescents with T1DM who had DKA during 2008-2018, and who were younger than age 18 years at the DKA event. Data were obtained from the patients’ medical files and included demographic data, medical history, and laboratory results. Recovery of DKA was defined as the resolution of acidosis (PH>7.3 and bicarbonate>15 meq/L).
Results: The mean time to recovery from DKA was significantly longer in patients with newly diagnosed than established diabetes (13± versus 8.5± hours) (p<0.001). This difference was maintained in an analysis according to DKA severity: mild, moderate, and severe. PH at presentation did not differ between the groups, but bicarbonate at presentation was significantly lower in patients with newly diagnosed diabetes than in those with established diabetes, 9.9± versus 12± mmol/L (p<0.001). Potassium and phosphorus levels were lower, and sodium and chloride levels were higher in patients with newly diagnosed diabetes than in those with established diabetes (p<0.001).
Conclusion: DKA is associated with shorter recovery time in patients with established compared to newly diagnosed diabetes. This may have implications on the treatment of people with established diabetes.