Evaluating the Impact of Acute Kidney Injury and Diabetic Ketoacidosis on Subsequent HbA1c in the First 36 Months in Children and Adolescents With New-Onset Type 1 Diabetes Mellitus.

BACKGROUND

Children and adolescents with new-onset Type 1 Diabetes Mellitus (T1D) experience high rates of both Acute Kidney Injury (AKI) and Diabetic Ketoacidosis (DKA). However, their relative impact on subsequent HbA1c is not well understood.

OBJECTIVES

To evaluate the relative effects of DKA and AKI on HbA1c levels within the first 36 months following diagnosis.

METHODS

Data was collected from a cohort of all children and adolescents presenting to a regional paediatric diabetes centre with new onset T1D between 2006 and 2016.

RESULTS

585 children were included, with a mean age of 8.9 years (SD 3.8) at diagnosis. 257 children (44%) had AKI, classified as 181 (70%) KDIGO stage 1, 61 (24%) stage 2, and 15 (6%) stage 3. 167 children (29%) presented with Diabetic Ketoacidosis (DKA). Overall, AKI at diagnosis was not associated with HbA1c at any time point. However, more severe AKI was associated with lower HbA1c at 6 months (p = 0.04). DKA at diagnosis was linked to higher HbA1c levels at 6, 12, and 24 months (p < 0.05), but there was no difference at 36 months.

CONCLUSIONS

Although both AKI and DKA are common at diagnosis in children and adolescents with T1D, it is DKA at diagnosis that is associated with higher HbA1c levels in follow-up. This highlights the importance of efforts to identify T1D early and prevent DKA. While more severe AKI was linked to lower HbA1c levels 6 months after diagnosis, replication is required in other cohorts.