Blanc N, Lucidarme N, Tubiana-Rufi N
Service d'endocrinologie et de diabétologie, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France.
Arch Pediatr. 2003 Apr;10(4):320-5. doi: 10.1016/s0929-693x(03)00033-2.
Type 1 diabetes in children in France is frequently diagnosed at the stage of ketoacidosis (DKA).
A prospective study was performed in a group of 72 children (mean age = 9.4 years) at onset of diabetes, in order to determine which factors were associated to DKA and to the severity of DKA (pH < 7.10) at diagnosis.
Younger age was related to DKA (p = 0.03), but not to its severity. A lesser frequency of DKA was found in children with a family history of insulin-treated diabetes ( p = 0.04). Misdiagnosis was more frequently observed in children with DKA than in children without DKA (p = 0.02) and in case of severe DKA at admission by comparison with non severe cases (76 vs 23%; p = 0.002). Children in low economic intake families exhibited more frequently a severe DKA (77 vs 23%; p = 0.002) and were more frequently misdiagnosed before admission (48% vs 10%; p < 0.01). Urine strips for glucose and ketone determinations were underused for diagnosis before admission (15% only).
Those results underline the need to both inform physicians and ameliorate the access to health care for low social class families, in order to take up the challenge of reducing the incidence of DKA at diagnosis in diabetic children in our country.
法国儿童1型糖尿病常于酮症酸中毒（DKA）阶段被诊断出来。
对一组72名糖尿病初发儿童（平均年龄 = 9.4岁）进行了一项前瞻性研究，以确定哪些因素与DKA以及诊断时DKA的严重程度（pH < 7.10）相关。
年龄较小与DKA相关（p = 0.03），但与DKA的严重程度无关。有胰岛素治疗糖尿病家族史的儿童发生DKA的频率较低（p = 0.04）。与无DKA的儿童相比，DKA儿童更常出现误诊（p = 0.02），与非重症DKA入院患儿相比，重症DKA入院患儿的误诊情况更常见（76% 对23%；p = 0.002）。经济收入低的家庭中的儿童更常出现重症DKA（77% 对23%；p = 0.002），且入院前更常被误诊（48% 对10%；p < 0.01）。入院前用于诊断的尿糖和尿酮试纸使用率较低（仅15%）。
这些结果强调了既要告知医生，又要改善低社会阶层家庭获得医疗保健的机会，以应对降低我国糖尿病儿童诊断时DKA发病率这一挑战。
