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Poon SWY, Tung JYL, Wong WHS, Cheung PT, Fu ACC, Pang GSW, To SWY, Wong LM, Wong WY, Chan SY, Yau HC, See WS, But BWM, Wong SMY, Lo PWC, Ng KL, Chan KT, Lam HY, Wong SWC, Lam YY, Yuen HW, Chung JYK, Lee CY, Tay MK, Kwan EYW. Diabetic ketoacidosis in children with new-onset type 1 diabetes mellitus: demographics, risk factors and outcome: an 11 year review in Hong Kong. J Pediatr Endocrinol Metab 2022; 35:1132-1140. [PMID: 36001345 DOI: 10.1515/jpem-2022-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Sarah Wing-Yiu Poon
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, P.R. China
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Pik-To Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Antony Chun-Cheung Fu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Gloria Shir-Wey Pang
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, P.R. China.,Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Sharon Wing-Yan To
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Lap-Ming Wong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, P.R. China
| | - Wai-Yu Wong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, P.R. China
| | - Suk-Yan Chan
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, P.R. China
| | - Ho-Chung Yau
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, P.R. China
| | - Wing-Shan See
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Betty Wai-Man But
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, P.R. China
| | | | - Priscilla Wai-Chee Lo
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, P.R. China
| | - Kwok-Leung Ng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, P.R. China
| | - Kwong-Tat Chan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, P.R. China
| | - Hi-Yuet Lam
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, P.R. China
| | - Sammy Wai-Chun Wong
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, P.R. China
| | - Yuen-Yu Lam
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, P.R. China
| | - Hoi-Wing Yuen
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, P.R. China
| | - Jacky Ying-Ki Chung
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, P.R. China
| | - Ching-Yee Lee
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, P.R. China
| | - Ming-Kut Tay
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong, P.R. China
| | - Elaine Yin-Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, P.R. China
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Alhazmi A, Sane F, Lazrek M, Nekoua MP, Badia-Boungou F, Engelmann I, Alidjinou EK, Hober D. Enteroviruses and Type 1 Diabetes Mellitus: An Overlooked Relationship in Some Regions. Microorganisms 2020; 8:microorganisms8101458. [PMID: 32977495 PMCID: PMC7598226 DOI: 10.3390/microorganisms8101458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) infect millions of people annually. EV infections can be asymptomatic or symptomatic with conditions ranging from mild illnesses to serious diseases such as dilated cardiomyopathy. A causal relationship between EV infections and type 1 diabetes mellitus (T1DM) has been heavily debated, with some studies suggesting that this relationship is not yet conclusive and requires additional evidence, whereas others strongly argue for this correlation. While this relationship is well investigated in some developed countries like the USA and Finland, it is understudied or neglected in other countries like Russia for many reasons such as the low incidence of T1DM. Although the Middle East and North Africa (MENA) are highly affected by T1DM, the role of EVs in the disease in MENA has not been investigated extensively. Therefore, we aimed to address the relationship between T1DM and EVs in MENA and other regions globally.
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Affiliation(s)
- Abdulaziz Alhazmi
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Microbiology and Parasitology Department, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Famara Sane
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Mouna Lazrek
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Magloire Pandoua Nekoua
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Laboratoire de Biologie et Physiologie Cellulaires, Institut des Sciences Biomédicales Appliquées (ISBA), Faculté des Sciences et Techniques (FAST), Université d’Abomey-Calavi, 01 BP 526 Cotonou, Benin
| | - Francis Badia-Boungou
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Ilka Engelmann
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Enagnon Kazali Alidjinou
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
| | - Didier Hober
- Laboratoire de Virologie ULR3610, Univ Lille, CHU Lille, F-59000 Lille, France; (A.A.); (F.S.); (M.L.); (M.P.N.); (F.B.-B.); (I.E.); (E.K.A.)
- Correspondence: ; Tel.: +33-3-20-44-66-88
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Lee HJ, Yu HW, Jung HW, Lee YA, Kim JH, Chung HR, Yoo J, Kim E, Yu J, Shin CH, Yang SW, Lee SY. Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents. J Korean Med Sci 2017; 32:303-309. [PMID: 28049242 PMCID: PMC5219997 DOI: 10.3346/jkms.2017.32.2.303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/16/2016] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to identify the risk factors for presence and severity of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in Korean children and adolescents. A retrospective chart review of children and adolescents newly diagnosed with T1DM was conducted in seven secondary and tertiary centers in Korea. Eligible subjects were < 20 years of age and had records on the presence or absence of DKA at the time of T1DM diagnosis. DKA severity was categorized as mild, moderate, or severe. Data were collected on age, height, body weight, pubertal status, family history of diabetes, delayed diagnosis, preceding infections, health insurance status, and parental education level. A total of 361 patients (male 46.3%) with T1DM were included. Overall, 177 (49.0%) patients presented with DKA at T1DM diagnosis. Risk factors predicting DKA at T1DM diagnosis were age ≥ 12 years, lower serum C-peptide levels, presence of a preceding infection, and delayed diagnosis. Low parental education level and preceding infection increased the severity of DKA. These results suggest that alertness of the physician and public awareness of diabetes symptoms are needed to decrease the incidence and severity of DKA at T1DM diagnosis.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeoh Won Yu
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaeho Yoo
- Department of Pediatrics, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Eunyoung Kim
- Department of Pediatrics, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Yong Lee
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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Mirsadraee R, Khajedaluee M, Vakili R, Hasanabade A, Saeedrezaee Z. Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-7462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Shoshan A, Sella T, Shohat T, Goren I, Shalev V, Chodick G. A case-crossover study of infectious diseases and new diagnosis of type 1 diabetes. Pediatr Diabetes 2012; 13:583-6. [PMID: 22765293 DOI: 10.1111/j.1399-5448.2012.00886.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/29/2012] [Accepted: 05/10/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infectious diseases have been associated with increased risk of type 1 diabetes (T1D). The objective of this case-crossover was to quantify the role of infectious diseases as triggers for T1D, 1 and 2 yr preceding disease diagnosis. METHODS All children aged 2-18 yr diagnosed with T1D between 2004 and 2009 among a two million member Israeli healthcare organization were identified (n = 368). For each patient, visits to physicians with symptomatic infectious diseases during 1 and 2 yr before T1D diagnosis were collected and compared. A similar analysis was conducted in a population of non-diabetic members matched on exact date of birth, sex and socioeconomic status (n = 307). RESULTS The rate of systemic viral infections was significantly higher in the year before T1D onset, as compared to the prior year [27 vs. 7%, respectively, odds ratio (OR) = 4.7, 95% confidence intervals (CI): 2.9-8.2]. This difference was most significant among patients diagnosed with T1D at the age of 2 to 6 (5 vs. 46%, respectively, OR = 27.0, 95% CI: 4.5-1105.4). Among non-T1D patients of the same age group, no difference was found in the proportion of patients with viral diseases 1 and 2 yr prior to T1D diagnosis (44 vs. 49%, respectively, OR = 0.8, 95% CI: 0.4-1.6). This unique association was limited only to viral diseases and to patients diagnosed with T1D at young age. CONCLUSIONS Our results indicate that T1D occurring in toddlers is characterized with a relatively low incidence of viral disease 2 yr prior to diagnosis and a much higher incidence in the subsequent year.
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Affiliation(s)
- Aushrat Shoshan
- Medical Division, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
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Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011; 343:d4092. [PMID: 21737470 PMCID: PMC3131115 DOI: 10.1136/bmj.d4092] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults. DESIGN Systematic review. DATA SOURCES PubMed, EMBASE, Web of Science, Scopus, and Cinahl and article reference lists. STUDY SELECTION Cohort studies including unselected groups of children and young adults presenting with new onset type 1 diabetes that distinguished between those who presented in diabetic ketoacidosis and those who did not and included a measurement of either pH or bicarbonate in the definition of diabetic ketoacidosis. There were no restrictions on language of publication. RESULTS 46 studies involving more than 24,000 children in 31 countries were included. Together they compared 23 different factors. Factors associated with increased risk were younger age (for <2 years old v older, odds ratio 3.41 (95% confidence interval 2.54 to 4.59), for <5 years v older, odds ratio 1.59 (1.38 to 1.84)), diagnostic error (odds ratio 3.35 (2.35 to 4.79)), ethnic minority, lack of health insurance in the US (odds ratio 3.20 (2.03 to 5.04)), lower body mass index, preceding infection (odds ratio 3.14 (0.94 to 10.47)), and delayed treatment (odds ratio 1.74 (1.10 to 2.77)). Protective factors were having a first degree relative with type 1 diabetes at the time of diagnosis (odds ratio 0.33 (0.08 to 1.26)), higher parental education (odds ratios 0.4 (0.20 to 0.79) and 0.64 (0.43 to 0.94) in two studies), and higher background incidence of type 1 diabetes (correlation coefficient -0.715). The mean duration of symptoms was similar between children presenting with or without diabetic ketoacidosis (16.5 days (standard error 6.2) and 17.1 days (6.0) respectively), and up to 38.8% (285/735) of children who presented with diabetic ketoacidosis had been seen at least once by a doctor before diagnosis. CONCLUSIONS Multiple factors affect the risk of developing diabetic ketoacidosis at the onset of type 1 diabetes in children and young adults, and there is potential time, scope, and opportunity to intervene between symptom onset and development of diabetic ketoacidosis for both parents and clinicians.
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Affiliation(s)
- Juliet A Usher-Smith
- General Practice and Primary Care Research Unit, University of Cambridge, Cambridge CB2 0SR, UK.
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Wang SV, Coull BA, Schwartz J, Mittleman MA, Wellenius GA. Potential for bias in case-crossover studies with shared exposures analyzed using SAS. Am J Epidemiol 2011; 174:118-24. [PMID: 21540322 DOI: 10.1093/aje/kwr038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The case-crossover method is an efficient study design for evaluating associations between transient exposures and the onset of acute events. In one common implementation of this design, odds ratios are estimated using conditional logistic or stratified Cox proportional hazards models, with data stratified on each individual event. In environmental epidemiology, where aggregate time-series data are often used, combining strata with identical exposure histories may be computationally convenient. However, when the SAS software package (SAS Institute Inc., Cary, North Carolina) is used for analysis, users can obtain biased results if care is not taken to properly account for multiple cases observed at the same time. The authors show that fitting a stratified Cox model with the "Breslow" option for handling tied failure times (i.e., ties = Breslow) provides unbiased health-effects estimates in case-crossover studies with shared exposures. The authors' simulations showed that using conditional logistic regression-or equivalently a stratified Cox model with the "ties = discrete" option-in this setting leads to health-effect estimates which can be biased away from the null hypothesis of no association by 22%-39%, even for small simulated relative risks. All methods tested by the authors yielded unbiased results under a simulated scenario with a relative risk of 1.0. This potential bias does not arise in R (R Foundation for Statistical Computing, Vienna, Austria) or Stata (Stata Corporation, College Station, Texas).
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Affiliation(s)
- Shirley V Wang
- Center for Environmental Health and Technology, Brown University, Providence, Rhode Island, USA
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Stene LC, Hyöty H. A novel approach to the investigation of potential precipitating factors in type 1 diabetes. Pediatr Diabetes 2006; 7:143-5. [PMID: 16787520 DOI: 10.1111/j.1399-543x.2006.00177.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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