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Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study

It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% no...

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Autores principales: Khanolkar, Amal R., Amin, Rakesh, Taylor-Robinson, David, Viner, Russell M., Warner, Justin, Gevers, Evelien F., Stephenson, Terence
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800126/
https://www.ncbi.nlm.nih.gov/pubmed/29295580
http://dx.doi.org/10.3390/ijerph15010026
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author Khanolkar, Amal R.
Amin, Rakesh
Taylor-Robinson, David
Viner, Russell M.
Warner, Justin
Gevers, Evelien F.
Stephenson, Terence
author_facet Khanolkar, Amal R.
Amin, Rakesh
Taylor-Robinson, David
Viner, Russell M.
Warner, Justin
Gevers, Evelien F.
Stephenson, Terence
author_sort Khanolkar, Amal R.
collection PubMed
description It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% non-white) attending paediatric diabetes clinics in East London. Data were extracted from routine medical registers. Subjects were categorized with normal, mild, moderate, or severe DKA. Linear mixed-effects modelling was used to assess differences in longitudinal HbA1(c) trajectories (glycaemic control) during 12 months post-diagnosis (1288 HbA1(c) data-points) based on DKA, adjusting for sex, age, ethnicity, SES (Socioeconomic Status) and treatment type. Females (OR 1.6, 95% CI 1.1–2.4) and younger age, 0–6 vs. 13–18 years (OR 2.9, 95% CI 1.5–5.6) had increased risk for DKA at diagnosis. Moderate or severe DKA was associated with higher HbA1(c) at diagnosis (adjusted estimates 8 mmol/mol, 2–14, and 10 mmol/mol, 4–15, respectively, compared to normal DKA). Differences in HbA1(c) trajectories by DKA were no longer apparent at six months post-diagnosis. All subjects experienced a steep decrease in HbA1(c) during the first three months followed by a gradual increase. While, DKA severity was not associated with glycaemic control at 12 months post-diagnosis, age at diagnosis, ethnicity, gender, and treatment type were significantly associated. For example, Black and mixed ethnicity children had increased risk for poor glycaemic control compared to White children (adjusted RRR 5.4, 95% CI 1.7–17.3 and RRR 2.5, 95% CI 1.2–6.0, respectively). DKA severity at diagnosis is associated with higher initial HbA1(c) but not glycaemic control from six months post-diagnosis. Age at diagnosis, ethnicity, gender, and insulin pump are associated with glycaemic control at one year post-diagnosis.
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spelling pubmed-58001262018-02-06 Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study Khanolkar, Amal R. Amin, Rakesh Taylor-Robinson, David Viner, Russell M. Warner, Justin Gevers, Evelien F. Stephenson, Terence Int J Environ Res Public Health Article It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% non-white) attending paediatric diabetes clinics in East London. Data were extracted from routine medical registers. Subjects were categorized with normal, mild, moderate, or severe DKA. Linear mixed-effects modelling was used to assess differences in longitudinal HbA1(c) trajectories (glycaemic control) during 12 months post-diagnosis (1288 HbA1(c) data-points) based on DKA, adjusting for sex, age, ethnicity, SES (Socioeconomic Status) and treatment type. Females (OR 1.6, 95% CI 1.1–2.4) and younger age, 0–6 vs. 13–18 years (OR 2.9, 95% CI 1.5–5.6) had increased risk for DKA at diagnosis. Moderate or severe DKA was associated with higher HbA1(c) at diagnosis (adjusted estimates 8 mmol/mol, 2–14, and 10 mmol/mol, 4–15, respectively, compared to normal DKA). Differences in HbA1(c) trajectories by DKA were no longer apparent at six months post-diagnosis. All subjects experienced a steep decrease in HbA1(c) during the first three months followed by a gradual increase. While, DKA severity was not associated with glycaemic control at 12 months post-diagnosis, age at diagnosis, ethnicity, gender, and treatment type were significantly associated. For example, Black and mixed ethnicity children had increased risk for poor glycaemic control compared to White children (adjusted RRR 5.4, 95% CI 1.7–17.3 and RRR 2.5, 95% CI 1.2–6.0, respectively). DKA severity at diagnosis is associated with higher initial HbA1(c) but not glycaemic control from six months post-diagnosis. Age at diagnosis, ethnicity, gender, and insulin pump are associated with glycaemic control at one year post-diagnosis. MDPI 2017-12-25 2018-01 /pmc/articles/PMC5800126/ /pubmed/29295580 http://dx.doi.org/10.3390/ijerph15010026 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Khanolkar, Amal R.
Amin, Rakesh
Taylor-Robinson, David
Viner, Russell M.
Warner, Justin
Gevers, Evelien F.
Stephenson, Terence
Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title_full Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title_fullStr Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title_full_unstemmed Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title_short Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
title_sort diabetic ketoacidosis severity at diagnosis and glycaemic control in the first year of childhood onset type 1 diabetes—a longitudinal cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800126/
https://www.ncbi.nlm.nih.gov/pubmed/29295580
http://dx.doi.org/10.3390/ijerph15010026
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