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Özel A, Erol EE, Yüce S, Büke Ö, Tahmiscioglu F, Erol M. Deciphering the role of lactate as a prognostic indicator in pediatric diabetic ketoacidosis. Wien Klin Wochenschr 2024:10.1007/s00508-024-02428-z. [PMID: 39259222 DOI: 10.1007/s00508-024-02428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/07/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION Serum lactate levels have been recognized as a robust marker for predicting disease severity and survival in many critically ill children but consensus is lacking regarding its utility in diabetic ketoacidosis. This study aimed to investigate the relationship between initial lactate levels and disease severity in pediatric patients presenting with diabetic ketoacidosis. METHODS This single-center retrospective descriptive study involved pediatric patients with diabetic ketoacidosis in the pediatric emergency department between January 2022 and April 2023. Patients were diagnosed using the International Society for Pediatric and Adolescent Diabetes 2022 guidelines. RESULTS Among the 112 patients included in the study, 41 (36.6%) were classified as mild, 42 (34.8%) as moderate and 32 (28.6%) as severe acidosis. A statistically significant difference was observed between the time to resolution and clinical severity of diabetic ketoacidosis (p < 0.001). Elevated lactate levels of 2.5 mmol/L or above were detected in 37.5% (42/112) of our patients and a significant increase in clinical severity was observed as lactate levels increased (p < 0.001). Correlation analysis revealed no significant relationship between lactate levels and time to resolution of diabetic ketoacidosis or length of intensive care unit stay. Multivariate analysis demonstrated a significant association between lactate levels and severity of acidosis (p: 0.046). CONCLUSION Although there is an association between the severity of acidosis and lactate levels in diabetic ketoacidosis, contrary to expectations, this relationship was not found to be associated with adverse outcomes. An important point not to be overlooked by pediatricians is that elevated lactate levels in diabetic ketoacidosis may not always herald poor outcomes.
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Affiliation(s)
- Abdulrahman Özel
- Bagcılar Training and Research Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Health Sciences University Turkey, Istanbul, Turkey.
| | - Esra Ecem Erol
- Bagcılar Training and Research Hospital, Department of Pediatrics, Health Sciences University Turkey, Istanbul, Turkey
| | - Servet Yüce
- Istanbul Faculty of Medicine, Department of Public Health, Istanbul University, Istanbul, Turkey
| | - Övgü Büke
- Bagcılar Training and Research Hospital, Department of Pediatrics, Health Sciences University Turkey, Istanbul, Turkey
| | - Feride Tahmiscioglu
- Bağcılar Training and Research Hospital, Department of Pediatric Endocrinology, Health Sciences University Turkey, Istanbul, Turkey
| | - Meltem Erol
- Bagcılar Training and Research Hospital, Department of Pediatrics, Health Sciences University Turkey, Istanbul, Turkey
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Muhammed Elamin S, Muhamad Arshad NF, Md Redzuan A, Abdul Aziz SA, Hong J, Chua XY, Bin-Abbas BS, Alsagheir A, Mohamed Shah N. Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study. BMJ Open 2024; 14:e079606. [PMID: 38569693 PMCID: PMC10989179 DOI: 10.1136/bmjopen-2023-079606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children's perspectives as well as their caregivers. DESIGN Qualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed. SETTING Participants were recruited from a tertiary care children's hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia. PARTICIPANTS Thirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia. RESULTS Four themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy. CONCLUSION This study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.
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Affiliation(s)
| | | | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Joyce Hong
- Department of Pediatric, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Xin Yun Chua
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Bassam Saleh Bin-Abbas
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Jiang Y, Zhu J, Lai X. Development and Validation of a Risk Prediction Model for Ketosis-Prone Type 2 Diabetes Mellitus Among Patients Newly Diagnosed with Type 2 Diabetes Mellitus in China. Diabetes Metab Syndr Obes 2023; 16:2491-2502. [PMID: 37614378 PMCID: PMC10443636 DOI: 10.2147/dmso.s424267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023] Open
Abstract
Background We established a nomogram for ketosis-prone type 2 diabetes mellitus (KP-T2DM) in the Chinese adult population in order to identify high-risk groups early and intervene in the disease progression in a timely manner. Methods We reviewed the medical records of 924 adults with newly diagnosed T2DM from January 2018 to June 2021. All patients were randomly divided into the training and validation sets at a ratio of 7:3. The least absolute shrinkage and selection operator regression analysis method was used to screen the predictors of the training set, and the multivariable logistic regression analysis was used to establish the nomogram prediction model. We verified the prediction model using the receiver operating characteristic (ROC) curve, judged the model's goodness-of-fit using the Hosmer-Lemeshow goodness-of-fit test, and predicted the risk of ketosis using the decision curve analysis. Results A total of 21 variables were analyzed, and four predictors-hemoglobin A1C, 2-hour postprandial blood glucose, 2-hour postprandial C-peptide, and age-were established. The area under the ROC curve for the training and validation sets were 0.8172 and 0.8084, respectively. The Hosmer-Lemeshow test showed that the prediction model and validation set have a high degree of fit. The decision curve analysis curve showed that the nomogram had better clinical applicability when the threshold probability of the patients was 0.03-0.79. Conclusion The nomogram based on hemoglobin A1C, 2-hour postprandial blood glucose, 2-hour postprandial C-peptide, and age has good performance and can serve as a favorable tool for clinicians to predict KP-T2DM.
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Affiliation(s)
- Yanjuan Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Jianting Zhu
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Xiaoyang Lai
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
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Majidi S, Roberts AJ, Suerken CK, Reboussin BA, Malik FS, Marcovina SM, Corathers S, Reynolds K, Imperatore G, Wadwa RP, Pihoker C. Health Care Transition to Adult Care in Type 1 Diabetes: Associations With Student and Employment Status-The SEARCH for Diabetes in Youth Study. Clin Diabetes 2023; 41:510-517. [PMID: 37849515 PMCID: PMC10577504 DOI: 10.2337/cd22-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Successful transition from a pediatric to adult diabetes care provider is associated with reduced ambulatory diabetes care visits and increased acute complications. This study aimed to determine whether the degree of independence in diabetes care and the rate of acute complications after transition to adult diabetes care were associated with individuals' student or employment status. Nonstudents were found to be less likely than students to be independent with diabetes care, and employed nonstudents were at lower risk of diabetic ketoacidosis than unemployed nonstudents. Additional support may be needed for young adults who are not students or are unemployed to improve independence and reduce the risk for acute complications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Washington, DC
| | - Alissa J. Roberts
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Alotaibi R, Alsulami M, Hijji S, Alghamdi S, Alnahdi Y, Alnahdi H, Samargandy SA. Diabetic ketoacidosis in Saudi Arabia: factors precipitating initial admission and readmission. Ann Saudi Med 2022; 42:119-126. [PMID: 35380064 PMCID: PMC8982000 DOI: 10.5144/0256-4947.2022.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the complications of diabetes mellitus (DM), primarily type 1 DM. To our knowledge, only one study explored DKA readmission rates in Saudi Arabia. OBJECTIVES Identify and analyze precipitating factors for DKA admission and readmission. DESIGN Medical record review. SETTING Tertiary care center. PATIENTS AND METHODS We identified all patients aged 15 years and older admitted with DKA from 2018 to 2020. Descriptive factors and uni-and multivariate analyses are presented for associations with initial admission and readmission. MAIN OUTCOME MEASURES Relationships between precipitating factors and initial admission and readmission. SAMPLE SIZE 176 patients. RESULTS Most of the patients had type 1 DM (n=157). The median (interquartile percentiles) for duration of DM was 6.0 (1.0-12.0) years. The mean (SD) HbA1C (%) was 11.8 (2.6). The factors that precipitated DKA were most commonly treatment nonadherence (55.1%), followed by infections (31.8%) and nonadherence to diet (25.6%). The most common symptoms were nausea and vomiting (87.5%), followed by abdominal pain (72.7%). During the study period, 32.4% of the sample were read-mitted with DKA. The median (interquartile range) duration between the first and second admission was 12 (4-25) weeks. In the multivariate analysis, increased odds of readmission for DKA were associated with type 1 DM and medication nonadherence (P=.038, P=.013, respectively). The severity of the initial DKA and the control of DM were not associated with the readmission rate. CONCLUSION Treatment nonadherence is the leading precipitating factor of DKA in our region. Patient education and counseling play a major role in addressing this preventable complication and its medical and financial burden. We advocate more efforts dedicated toward patient education and logistic support. LIMITATIONS Retrospective-single center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Raghad Alotaibi
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Manar Alsulami
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Sumiah Hijji
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Saad Alghamdi
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Yasser Alnahdi
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Haifa Alnahdi
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Shaza Ahmed Samargandy
- From the Department of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
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Alshaikh AA, Alsalman RZ, Albarqi NH, Alqahtani RS, Almontashri AA, Alshahrani AS, Alshehri MA. Incidence of Diabetic Ketoacidosis among Adults with Type 1 Diabetes in Saudi Arabia: Systematic review. PHARMACOPHORE 2022. [DOI: 10.51847/e1vwtogf5k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Al Hayek AA, Al Dawish MA. Frequency of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Using FreeStyle Libre: A Retrospective Chart Review. Adv Ther 2021; 38:3314-3324. [PMID: 34009604 PMCID: PMC8131878 DOI: 10.1007/s12325-021-01765-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/28/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is an acute complication associated with poorly managed or undiagnosed diabetes. DKA is associated with significant morbidity, mortality, and healthcare costs, but can be prevented with appropriate management of diabetes. The FreeStyle Libre is flash glucose monitoring device that measures glucose levels in the interstitial subcutaneous tissue and has been shown to reduce HbA1c, time in hypoglycemia and hyperglycemia, as well as improve health-related quality of life. METHODS A retrospective chart review of patients with type 1 diabetes mellitus (T1DM) and recurrent DKA and who initiated FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) was conducted. DKA frequency and severity, glycated hemoglobin (HbA1c), and frequency of blood glucose monitoring were compared between the 2-year period before FreeStyle Libre initiation and the 2-year period after FreeStyle Libre initiation. RESULTS A total of 47 patients with T1DM with recurrent DKA were included. FreeStyle Libre was associated with a reduction in the frequency of DKA events, with a mean of 0.2 (standard deviation [SD] 0.4) events per person during the 2 years after FreeStyle Libre initiation versus 2.9 (SD 0.9) during the 2 years before FreeStyle Libre initiation. Severity of DKA events was also reduced, with fewer severe (before mean 0.3 [SD 0.5] versus after 0.0 [SD 0.0]; p < 0.001) DKA events. A reduction in HbA1c (mean 7.4% [SD 0.5] after versus 9.9% [SD 1.2] before [p < 0.001]) and an increase in frequency of blood glucose testing (mean 8.1 scans/day [SD 1.7] after versus 2.2 finger-pricks/day [SD 0.7] at before [p < 0.001]) were also observed. CONCLUSION FreeStyle Libre is associated with a reduction in the frequency and severity of DKA events, reduction in HbA1c, and increase in frequency of blood glucose testing in patients with T1DM and recurrent DKA. The use of such a glucose monitoring tool can help to reduce the burden of morbidity, mortality, and healthcare costs associated with complications of diabetes.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia.
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
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