Choleau C, Maitre J, Filipovic Pierucci A, Elie C, Barat P, Bertrand A-M, de Kerdanet M, Letallec C, Levy-Marchal C, Nicolino M, Tubiana-Rufi N, Cahané M, Robert J-J
Aide aux jeunes diabétiques, 9, avenue Pierre-de-Coubertin, 75013 Paris, France.
Aide aux jeunes diabétiques, 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et de l'adolescent, université René-Descartes-Sorbonne-Paris-Cité, hôpital Necker-Enfants Malades, AP-HP, Paris, France.
Diabetes Metab. 2014 Apr;40(2):137-42. doi: 10.1016/j.diabet.2013.11.001. Epub 2013 Dec 11.
This study aimed to evaluate the frequency of diabetic ketoacidosis (DKA) and its associated factors at the diagnosis of type 1 diabetes (T1D) in French children and adolescents prior to launching a public-health campaign of information to prevent DKA.
Over a 1-year period, 1299 youngsters (aged < 15 years) were diagnosed with T1D at 146 paediatric centres in all regions of France. Age, gender, duration of symptoms, patient's pathway to diagnosis, clinical and biological signs, and family history of T1D were collected for each newly diagnosed patient. DKA was defined as pH < 7.30 or bicarbonate < 15 mmol/L, and severe DKA as pH < 7.10 or bicarbonate < 5 mmol/L.
At the time of diagnosis, 26% of the children were aged 0-5 years, 34% were 5-10 years and 40% were 10-15 years. The overall prevalence of DKA was 43.9% (0-5 years: 54.2%; 5-10 years: 43.4%; and 10-15 years: 37.1%) and 14.8% for severe DKA (0-5 years: 16.6%; 5-10 years: 14.4%; and 10-15 years: 13.9%; < 2 years: 25.3%). Severe DKA was more frequent when the child was hospitalized at the family's behest (26.6%) than when referred by a general practitioner (7.6%) or paediatrician (5.1%; 30.6%, 53.7% and 9.2%, respectively, by patients' age group). The frequency of DKA decreased to 20.1% (severe DKA: 4.4%) in families with a history of T1D. Multivariate analysis showed that age, pathway to diagnosis, duration of polyuria/polydipsia (< 1 week) and family history of T1D were associated with the presence of DKA, while pathway to diagnosis and family history of T1D were associated with severe DKA.
DKA at the time of T1D diagnosis in children and adolescents is frequent and often severe. Patients' age, pathway to hospitalization and family history of diabetes were the main factors associated with DKA. These data suggest that a public-health campaign to prevent DKA at diagnosis can help reduce the frequency of DKA and also provide baseline data for evaluating the efficacy of such a campaign.
本研究旨在评估在开展预防糖尿病酮症酸中毒（DKA）的公共卫生宣传活动之前，法国儿童和青少年1型糖尿病（T1D）诊断时DKA的发生率及其相关因素。
在1年的时间里，法国所有地区的146家儿科中心诊断出1299名年龄小于15岁的青少年患有T1D。收集每位新诊断患者的年龄、性别、症状持续时间、诊断途径、临床和生物学体征以及T1D家族史。DKA定义为pH<7.30或碳酸氢盐<15 mmol/L，严重DKA定义为pH<7.10或碳酸氢盐<5 mmol/L。
诊断时，26%的儿童年龄在0至5岁之间，34%为5至10岁，40%为10至15岁。DKA的总体患病率为43.9%（0至5岁：54.2%；5至10岁：43.4%；10至15岁：37.1%），严重DKA为14.8%（0至5岁：16.6%；5至10岁：14.4%；10至15岁：13.9%；<2岁：25.3%）。当儿童应家人要求住院时，严重DKA的发生率更高（26.6%），而由全科医生转诊时（7.6%）或儿科医生转诊时（5.1%；按患者年龄组分别为30.6%、53.7%和9.2%）则较低。有T1D家族史的家庭中，DKA的发生率降至20.1%（严重DKA：4.4%）。多因素分析显示，年龄、诊断途径、多尿/多饮持续时间（<1周）和T1D家族史与DKA的发生有关，而诊断途径和T1D家族史与严重DKA有关。
儿童和青少年T1D诊断时DKA很常见且往往很严重。患者年龄、住院途径和糖尿病家族史是与DKA相关的主要因素。这些数据表明，在诊断时开展预防DKA的公共卫生宣传活动有助于降低DKA的发生率，并为评估此类活动的效果提供基线数据。
