Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

Background. Diabetic ketoacidosis (DKA) is a life-threatening condition frequently present at type 1 diabetes diagnosis (T1D). Younger children are at greater risk of developing this acute complication. It is alarming due to worldwide rise in T1D incidence with the greatest increase in children aged < 5 years. The aim of this study was to identify the prevalence of DKA and factors related to its occurrence in children at T1D diagnosis from Wielkopolska province in Poland. Methods. The study cohort comprised 735 children (girls: 329; boys: 406) aged 0-18 years with new onset T1D admitted to one hospital between 2009 and 2014. The mean age at diagnosis was 9.3 years. DKA was defined as blood pH < 7.30. To confirm autoimmune diabetes origin typical autoantibodies were tested. Results. DKA was diagnosed in 36% of patients with newly diagnosed T1D. DKA occurred significantly more often in children aged < 4 years (p = 0.001). The highest prevalence of DKA was associated with symptoms' duration (> 28 days) (p = 0.014) and diabetes misdiagnosis (p = 0.001). Autoantibody against zinc transporter 8 was detected significantly more often in children with DKA (p = 0.044). In the group with DKA, glycated hemoglobin level was significantly higher (p = 0.0004), while insulin and C-peptide levels were lower (p = 0.0001 and p = 0.0001, respectively). Conclusions. The prevalence of DKA is high and its severity is substantial in children with newly diagnosed T1D from Wielkopolska province. Diabetes misdiagnosis, symptoms' duration and age under 4 years are the most common risk factors of DKA development at T1D onset. Autoantibody against zinc transporter 8 is associated with acute T1D onset.