Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
J Pediatr. 2013 Feb;162(2):330-4.e1. doi: 10.1016/j.jpeds.2012.06.058. Epub 2012 Aug 15.
To define the demographic and clinical characteristics of children at the onset of type 1 diabetes (T1D), with particular attention to the frequency of diabetic ketoacidosis (DKA).
The Pediatric Diabetes Consortium enrolled children with new-onset T1D into a common database. For this report, eligible subjects were aged <19 years, had a pH or HCO(3) value recorded at diagnosis, and were positive for at least one diabetes-associated autoantibody. Of the 1054 children enrolled, 805 met the inclusion criteria. A pH of <7.3 and/or HCO(3) value of <15 mEq/L defined DKA. Data collected included height, weight, hemoglobin A1c, and demographic information (eg, race/ethnicity, health insurance status, parental education, family income).
The 805 children had a mean age of 9.2 years, 50% were female; 63% were non-Hispanic Caucasian. Overall, 34% of the children presented in DKA, half with moderate or severe DKA (pH <7.2). The risk for DKA was estimated as 54% in children aged <3 years and 33% in those aged ≥ 3 years (P = .006). In multivariate analysis, younger age (P = .002), lack of private health insurance (P < .001), African-American race (P = .01), and no family history of T1D (P = .001) were independently predictive of DKA. The mean initial hemoglobin A1c was higher in the children with DKA compared with those without DKA (12.5% ± 1.9% vs 11.1% ± 2.4%; P < .001).
The incidence of DKA in children at the onset of T1D remains high, with approximately one-third presenting with DKA and one-sixth with moderate or severe DKA. Increased awareness of T1D in the medical and lay communities is needed to decrease the incidence of this life-threatening complication.
定义 1 型糖尿病（T1D）发病时儿童的人口统计学和临床特征，特别关注糖尿病酮症酸中毒（DKA）的频率。
儿科糖尿病联合会将新诊断为 T1D 的儿童纳入一个共同的数据库。在本报告中，符合条件的受试者年龄<19 岁，在诊断时记录了 pH 值或 HCO3 值，并且至少有一种与糖尿病相关的自身抗体呈阳性。在纳入的 1054 名儿童中，805 名符合纳入标准。pH 值<7.3 和/或 HCO3 值<15 mEq/L 定义为 DKA。收集的数据包括身高、体重、血红蛋白 A1c 和人口统计学信息（例如，种族/民族、健康保险状况、父母教育程度、家庭收入）。
805 名儿童的平均年龄为 9.2 岁，50%为女性；63%是非西班牙裔白种人。总体而言，34%的儿童出现 DKA，其中一半为中度或重度 DKA（pH<7.2）。年龄<3 岁的儿童 DKA 风险估计为 54%，年龄≥3 岁的儿童为 33%（P=0.006）。在多变量分析中，年龄较小（P=0.002）、缺乏私人健康保险（P<0.001）、非裔美国人种族（P=0.01）和无 T1D 家族史（P=0.001）是 DKA 的独立预测因素。与无 DKA 的儿童相比，DKA 儿童的初始血红蛋白 A1c 更高（12.5%±1.9%比 11.1%±2.4%；P<0.001）。
儿童 T1D 发病时 DKA 的发生率仍然很高，约三分之一出现 DKA，六分之一出现中度或重度 DKA。需要提高医疗和非医疗社区对 T1D 的认识，以降低这种危及生命的并发症的发生率。
