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Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes

Abstract

Background

The objective of this study was to describe the differences in metabolic parameters and in time to recovery from diabetes ketoacidosis (DKA), between children and adolescents with newly diagnosed diabetes compared with established type 1 diabetes (T1DM).

Methods

This was a single-center, retrospective study. The cohort consists of 356 children and adolescents with T1DM who had DKA during 2008–2018. Data were obtained from the patients’ medical files. Recovery of DKA was defined as the resolution of acidosis (pH >7.3 and bicarbonate >15 meq/L).

Results

The mean time to recovery from DKA was significantly longer in patients with newly diagnosed diabetes than in those with established diabetes (13± versus 8.5± h) (p < 0.001). This difference was maintained in an analysis according to DKA severity: mild, moderate, and severe. pH at presentation did not differ between the groups, but bicarbonate at presentation was significantly lower in patients with newly diagnosed diabetes than in those with established diabetes, 9.9± versus 12± mmol/L (p < 0.001). Potassium and phosphorus levels were lower, and sodium and chloride levels were higher in patients with newly diagnosed diabetes than in those with established diabetes (p < 0.001).

Conclusions

DKA is associated with a shorter recovery time in patients with established diabetes compared to newly diagnosed diabetes. This may have implications on the treatment of people with established diabetes.

Impact

  • DKA is associated with a shorter recovery time in patients with established diabetes compared with newly diagnosed diabetes.

  • Shorter recovery time in a patient with established diabetes compared with newly diagnosed diabetes was observed in any DKA severity.

  • The time to recovery from DKA did not differ significantly between patients treated with an insulin pump and those treated with multiple daily injections.

  • Triggers for DKA among patients with established diabetes were poor compliance with treatment, infection, pump dysfunction, and dehydration.

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Fig. 1: Time to resolution of DKA according to the severity and timing of diabetes ketoacidosis (DKA) (at diabetes onset and during the course of diabetes).

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Authors

Contributions

All the authors contributed to the study design and methods and advised on analysis or interpretation of the data. K.S.-Z. collected the data and wrote the first draft of the manuscript. All the authors commented and revised the manuscript and approved the submitted version. M.Y.-G. performed the statistical analysis.

Corresponding author

Correspondence to Revital Nimri.

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Competing interests

The authors declare no competing interests.

Consent statement

The study was approved by the local Institutional Review Board (0786-18-RMC). This was a retrospective study, and no patient consent was required.

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Smuel-Zilberberg, K., Shalitin, S., Yackobovitch-Gavan, M. et al. Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01618-z

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