Department of Pediatric Diabetology and Pediatrics, Pediatric Teaching Clinical Hospital of the Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
Students' Scientific Association, Medical University of Warsaw, Warsaw, Poland.
BMC Endocr Disord. 2021 Nov 2;21(1):218. doi: 10.1186/s12902-021-00882-8.
The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up.
The study included children treated due to newly diagnosed T1D complicated with DKA between 2010 and 2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA, total daily insulin dose, basal insulin and BMI-SDS.
85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA level (7,3%vs7,2%;p = .413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA. The method of insulin delivery at baseline was significantly associated with HbA levels after 5 years of observation, β = - 1.46,95%CI[- 2.01 to - 0.92],p < .001.
The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA improvement.
本研究旨在评估糖尿病诊断时是否存在 DKA 是否与 5 年随访期间代谢控制较差有关。
本研究纳入了 2010 年至 2014 年间因新发 T1D 合并 DKA 而接受治疗并完成完整 5 年随访的儿童。在每种情况下，我们都根据年龄、性别和 BMI 进行个体匹配，与未发生 DKA（nDKA）的患者进行匹配（n = 85）。我们收集了有关治疗方式、HbA、总日胰岛素剂量、基础胰岛素和 BMI-SDS 的数据。
85 名儿童的糖尿病诊断时存在 DKA，中位年龄为 7.93 岁。pH 值中位数为 7.19。两组中 87%的患者均使用持续皮下胰岛素输注（CSII）。疾病持续 5 年后，HbA 水平（7.3%对 7.2%；p = 0.413）无差异。酮症酸中毒的严重程度对 HbA 无显著影响。基线时胰岛素给药方式与 5 年后的 HbA 水平显著相关，β= -1.46，95%CI[-2.01 至 -0.92]，p < 0.001。
在使用现代技术的儿童中，糖尿病诊断时存在 DKA 与长期代谢控制恶化无关。早期将 CSII 应用于糖尿病治疗可能会改变 DKA 的影响，并导致长期 HbA 改善。
