Endocrine Abstracts

Children and young people (CYP) at clinical onset of Type 1 diabetes (T1D) usually present with the classical symptoms of polyuria, polydipsia and weight loss with evidence of hyperglycaemia. A proportion with new onset T1D progress to metabolic decompensation and present with diabetic ketoacidosis (DKA), characterised by hyperglycemia and acidosis. DKA is a major medical emergency which untreated results in coma and death. The proportion of those with DKA at diabetes onset varies widely in different populations, with many developed countries, including Ireland, reporting extremely high rates of 40%. DKA is potentially fatal, primarily due to cerebral oedema. Up to 35% of those who survive cerebral oedema have ongoing morbidity. Those who experience DKA at diabetes diagnosis have evidence of morphological and functional brain changes. Even uncomplicated DKA is associated with lower cognitive function. Poor glycaemic control at diabetes diagnosis is associated with increased diabetes related complications in young adults and increased mortality evident even 27 years later. Poor metabolic control at diagnosis establishes a trajectory of poor control evident many years later. The severity of DKA at diagnosis impacts glycaemic control up to 15 years later where those with severe DKA at diagnosis have an HbA1c which tracks 1.4% higher than those without DKA. DKA at diabetes diagnosis is considered a modifiable factor with earlier presentation to clinical services preventing the development of DKA in the majority. Increased awareness of the symptoms of T1D among the medical community and general population is thought to promote earlier presentation to clinical services and prevent DKA at diagnosis. The first health promotion campaign in Italy, the Parma campaign had a dramatic impact reducing DKA from 78% to 12.5%. The “TEST” campaign is underway to target the very high DKA rate in Ireland. Preventing DKA at diabetes diagnosis is a key therapeutic target.