Endocrine Abstracts

Background: Diabetic ketoacidosis (DKA) is a common presentation of newly diagnosed type 1 diabetes (T1DM) in children but increases the disease burden at diagnosis. In UK, average frequency of DKA presentation is reported as 25% with an international variation of 16 to 67%. Data on frequency variations within the UK is limited.

Aim: To compare the demographic and clinical characteristics of DKA vs non-DKA presentations in children <16 years at diagnosis of T1DM.

Methods: This was a retrospective audit of newly diagnosed children with T1DM over a 30 month period; (January 2013–June 2015), in a single paediatric diabetes unit.

Results: children presented with new onset T1DM. Median age was 8.0 years (range 2–16 years); 56% were females. 42% (n=15) presented in DKA (DKA+) and the rest with hyperglycaemia and +/− Ketosis (DKA−). Most DKA+ had either mild (40%) or moderate (33%) degree of DKA. There was no difference in the proportion of males (40%) or females (43%) presenting in DKA+ vs DKA−. Overall, 47% of children were diagnosed in a primary care setting, with no difference between the two groups. 19% had a family history of T1DM. Commonest symptoms were polydipsia (93%), polyuria (86%), and weight loss (66%) and were similar in both groups except abdominal pain which was more common in DKA+ group (33% vs 4.7%), (P=0.059). 100% of children of African ethnicity presented in DKA compared to33% of white British ethnicity, (P=0.0261). Mean length of stay was longer (P=0.001) in DKA+ (8.8 days; range 5–14) compared to DKA− (6.4 days; range 4–9). There was a trend for younger children to present in DKA with 66% of those aged 0–5 years presenting in DKA compared to 29 and 46% in 5–9 years and 10–16 years respectively (not statistically significant). There was no seasonal difference.

Conclusions: Rate of DKA at presentation of T1DM in our patients was higher than that reported in the literature. More patients were diagnosed in hospital than in primary care, highlighting the need to increase awareness amongst public and primary care health professionals to aid early diagnosis and reduce the burden of DKA. Particular attention in this regard should be paid to younger children and those from ethnic minorities.