MON-107 Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children from a Large Centre (Hangzhou, China)

Objective: To review the clinical symptoms and biochemical parameters associated with diabetic ketoacidosis (DKA) in children newly diagnosed with type 1 diabetes (T1D) in our single medical centre over 10 years. Methods: Participants were children aged <16 years diagnosed with T1D between 1 January 2009 and 31 December 2018 at the Children’s Hospital, at Zhejiang University School of Medicine (Hangzhou, China). DKA occurrence was assessed by blood gases using pH and bicarbonate. The severity of DKA was categorized according to ISPAD 2014 guidelines, as mild, moderate, or severe. The child’s history prior to diagnosis was recorded, and patients underwent a number of clinical assessments, including anthropometry, biochemical parameters, and OGTT. The demographic and clinical characteristics of children with and without DKA were compared. Results: 681 patients (314 boys and 367 girls) were diagnosed with T1D over the study period. 341 (50.1%) had DKA at diagnosis, with yearly rates ranging from 45.0% to 56.8%. Eight cases had missing data on severity, but 120 had mild (36.0%), 100 moderate (30.0%), and 113 severe (33.9%) DKA. Children with DKA were younger than those without DKA (7.2 vs 8.2 years, respectively; p=0.001), and were more likely to report vomiting (13.2% vs 1.5%; p<0.001), loss of appetite (3.2% vs 0.9%; p=0.031), fatigue (39.3% vs 5.6%; p<0.001), and abdominal pain (9.1% vs 1.5%; p<0.001) prior to T1D diagnosis. The classical symptoms of diabetes were similar in children with and without DKA, such as polyuria (86.8% vs 90.3%, respectively; p=0.153), polydipsia (90.6% vs 91.5%; p=0.696), polyphagia (26.4% vs 30.3%; p=0.259), and weight loss (50.7% vs 50.6%; p=0.970). Children with DKA had higher blood lipids and fasting insulin levels at presentation, but displayed similar HbA1c levels. Conclusions: We report a high incidence of DKA at our centre (50%) among children diagnosed with T1D. As most children displayed classical symptoms of diabetes, it is important to increase community awareness of the disease to ensure an early diagnosis and lower the risk of children presenting with DKA.