Endocrine Abstracts

JOINT2017

Objective: The diverse clinical presentations, increasing prevalence and incidence rates of type 1 diabetes mellitus (T1DM) have escalated the need for emergency department (ED) visits and hospital admissions. This study aimed to evaluate the characteristics and distributions of all ED visits—both diabetes-related and unrelated, requiring or not requiring hospital admission—among pediatric patients diagnosed with T1DM.

Materials and Methods: This retrospective study included 201 pediatric and adolescent patients who had been followed with a T1DM diagnosis for at least one year and presented to the Pediatric Emergency Department of Ankara Etlik City Hospital between October 1, 2022, and March 1, 2024. Patient data included sociodemographic characteristics, details of diabetes diagnosis and management, ED visit information, and laboratory findings.

Results: Among a total of 201 patients, 92 (46%) were using continuous glucose monitoring (CGM) devices, and 17 (8. 5%) were using insulin pumps. The mean HbA1c level over the past year was 8. 75±2. 51%, and 61 patients (29. 4%) had not undergone an HbA1c measurement within the last three months. Between October 2022 and March 2024, there were a total of 345 ED visits, 50. 4% of which were diabetes-related, while 49. 6% were due to non-diabetes-related causes. Vomiting was the most common presenting complaint. Regarding the most recent ED visits, 15. 9% (n = 32) were due to hyperglycemia, 11. 4% (n = 23) due to ketosis, 26. 4% (n = 53) due to diabetic ketoacidosis (DKA), 13. 9% (n = 28) due to hypoglycemia, 26. 9% (n = 54) due to infections, and 5. 5% (n = 11) due to other reasons. Patients presenting with DKA had higher mean ages, higher diabetes diagnosis ages, higher daily insulin doses, and higher mean HbA1c levels compared to those with other diabetes-related presentations (P < 0. 001). The CGM usage rate among DKA patients (n = 8; 15. 1%) was significantly lower than that of patients presenting with other diabetes-related conditions (P < 0. 001). Patients with lower basal insulin percentages, those using antidepressant therapy, and those who were diagnosed with diabetes during a DKA episode had a higher likelihood of developing DKA during periods of illness.

Conclusion: Our study found that the clinical reasons for ED visits among pediatric patients with T1DM were closely associated with their metabolic control status and demographic characteristics. The majority of diabetes-related visits were accompanied by infections. Diabetes education for patients and caregivers should emphasize the importance of glycemic regulation during periods of illness. Regular follow-ups in collaboration with diabetes care teams are essential for improving diabetes management and reducing the long-term burden on emergency services.