Risk factors for ketosis in newly diagnosed type 1 diabetes in Lithuanian pediatric population

Abstract

Background: Diabetic ketoacidosis remains a serious condition in newly diagnosed type 1 diabetes (T1D) in children with a frequency varying from 25 to 70% in different countries. Objectives: To test if there is an association of diabetic ketosis at presentation with age, autoimmunity status and family history of diabetes in the Lithuanian pediatric population. Methods: Study sample consisted of 256 newly diagnosed T1D in children less than 18 yrs in Lithuania since 2007 in whom pancreatic antibodies tests were available. Results: At presentation, 22.8% of children were 0–4 years old, 28.3% - 5–9 years old, 42.9% - 10–14 years old and 5.9% older than 14 years. Frequency of ketosis at presentation was 67.2%. 24.2% of children had positive family history of diabetes among first, second or thirddegree relatives. Tyrosine phosphatase antibodies (IA2) alone were found in 20.7%, glutamic acid decarboxylase antibodies (GAD65) alone - in 19.3%; both types of antibodies - in 53.1% of cases; 6.9% of children were antibody-negative.No significant association between ketosis at the onset of disease and age groups was found (p=0.95). Ketosis at the diagnosis was present in 55% of patients without family history of diabetes and only in 12% in those with positive family history (p=0.02). Diabetic ketosis was found in 76.7% of children with positive IA2 antibodies, in 60.7% - with positive GAD65 antibodies, in 71,4% - with both types of antibodies, and in 30% in antibody-negative children (Fisher exact p=0.074). Conclusions: Ketosis in newly diagnosed diabetes cases in childhood in Lithuania was more frequent among children without family history of diabetes, but not related to age at presentation. A trend towards more frequent ketosis was found in children with positive pancreatic antibodies, especially IA2 and a combination of IA2 and GAD65.