Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Liggins Institute, University of Auckland, Auckland, New Zealand.
Front Endocrinol (Lausanne). 2021 Apr 27;12:653519. doi: 10.3389/fendo.2021.653519. eCollection 2021.
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes (T1D), and a leading cause of death in children aged <15 years with new-onset T1D.
i) to assess the incidence of DKA in children and adolescents newly diagnosed with T1D over a 10-year period at a large regional center in China; and ii) to examine the clinical symptoms and demographic factors associated with DKA and its severity at diagnosis.
We carried out a retrospective audit of a regional center, encompassing all youth aged <16 years diagnosed with T1D in 2009-2018 at the Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China). DKA and its severity were classified according to ISPAD 2018 guidelines.
681 children were diagnosed with T1D, 50.1% having DKA at presentation (36.0% mild, 30.0% moderate, and 33.9% severe DKA). The number of patients diagnosed with T1D progressively rose from approximately 39 cases/year in 2009-2010 to 95 cases/year in 2017-2018 (≈2.5-fold increase), rising primarily among children aged 5-9 years. DKA incidence was unchanged but variable (44.8% to 56.8%). At T1D diagnosis, 89% of patients reported polyuria and 91% polydipsia. Children presenting with DKA were more likely to report vomiting, abdominal pain, and particularly fatigue. DKA was most common among the youngest children, affecting 4 in 5 children aged <2 years (81.4%), in comparison to 53.3%, 42.7%, and 49.3% of patients aged 2-4, 5-9, and ≥10 years, respectively. Children with severe DKA were more likely to report vomiting, fatigue, and abdominal pain, but less likely to report polyuria, polydipsia, and polyphagia than those with mild/moderate DKA. Rates of severe DKA were highest in children aged <2 years (51.1%).
The number of children diagnosed with T1D at our regional center increased over the study period, but DKA rates were unchanged. With 9 of 10 children reporting polyuria and polydipsia prior to T1D diagnosis, increasing awareness of this condition in the community and among primary care physicians could lead to earlier diagnosis, and thus potentially reduce rates of DKA at presentation.
糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1D）的一种潜在危及生命的并发症，也是新诊断为 T1D 的 <15 岁儿童死亡的主要原因。
i）评估在中国一家大型地区中心的 10 年内新诊断为 T1D 的儿童和青少年中 DKA 的发病率；ii）研究与 DKA 及其严重程度相关的临床症状和人口统计学因素。
我们对浙江大学医学院附属儿童医院（杭州，中国） 2009-2018 年期间诊断为 T1D 的所有 <16 岁的青少年进行了地区中心的回顾性审核。DKA 和其严重程度根据 ISPAD 2018 指南进行分类。
共诊断了 681 例儿童 T1D，50.1%的患儿在就诊时患有 DKA（轻度 36.0%，中度 30.0%，重度 33.9%）。诊断为 T1D 的患者人数从 2009-2010 年的约 39 例/年增加到 2017-2018 年的 95 例/年（增加了约 2.5 倍），主要是在 5-9 岁的儿童中。DKA 的发病率保持不变，但有所波动（44.8%至 56.8%）。在 T1D 诊断时，89%的患者报告有多尿，91%的患者报告有多饮。患有 DKA 的患儿更有可能报告呕吐、腹痛，特别是疲劳。DKA 最常见于年龄最小的儿童，81.4%的 <2 岁儿童有 4 例，而 2-4 岁、5-9 岁和≥10 岁的患儿分别有 53.3%、42.7%和 49.3%。患有严重 DKA 的患儿更有可能报告呕吐、疲劳和腹痛，但报告多尿、多饮和多食的可能性低于轻度/中度 DKA 的患儿。严重 DKA 的发生率在 <2 岁的儿童中最高（51.1%）。
本地区中心诊断为 T1D 的患儿数量在研究期间有所增加，但 DKA 的发病率并未改变。90%的患儿在 T1D 诊断前就已报告有多尿和多饮，因此提高社区和初级保健医生对这种疾病的认识，可能会导致更早的诊断，从而降低 DKA 的就诊率。
