ECEESPE2025 Rapid Communications Rapid Communications 2: Diabetes and Insulin Part 1 (6 abstracts)
Stable age at diagnosis and persistently high incidence of inaugural diabetic ketoacidosis in children with type 1 diabetes: insights from french diabetic ketoacidosis observatory (2010–2023)
Pollé Olivier 1 , Gaelle Vermillac 1,2 , Carine Choleau 3 , Dalila Louet 3 , Diletta Ingrosso 1,4 , Marc de Kerdanet 3 , Sabine Baron 5 , Regis Coutant 3,6 , Carine Villanueva 7 , Claire Levy-Marchal 3 , Pascal Barat 8 & Jacques Beltrand 1,2
1Hôpital Universitaire Necker Enfants-Malades, Pediatric Endocrinology and Diabetes, Paris, France; 2Institut Cochin, Inserm U 10116, Paris, France; 3AJD (Aide aux Jeunes Diabétiques), Help to the Young Diabetics, Paris, France; 4University of Chiety, Department of Paediatrics, Chieti, Italy; 5CHU Nantes, Pediatrics Department, Nantes, France; 6CHU d’Angers, Unité d’ Endocrinologie Diabetologie Pédiatrique, Angers, France; 7Pediatric Endocrinology, Diabetology and Metabolism Department, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France; 8Bordeaux University Hospital, Pediatric Endocrinology Unit, Bordeaux, France
JOINT1396
Introduction: Diabetic ketoacidosis (DKA), a serious metabolic complication resulting from near-total insulin deficiency, is often associated with the initial presentation of type 1 diabetes (T1D) in children. Although DKA is transient at the time of diagnosis, it is associated with both medium- and long-term adverse outcomes. The incidence of DKA varies between countries. It is influenced by multiple factors including age, socioeconomic status and public awareness. The aim of this study is to evaluate for the first time the evolution of inaugural DKA in France over the past ten years.
Materials and methods: Data were collected from the national AJD (Aide aux Jeunes Diabetiques) registry, which collects data on paediatric patients with new-onset T1D (aged 0-15 years) from approximately 70% of the national clinics between 2010 and 2023. DKA was defined according to ISPAD criteria. Student’s t-test, chi-squared test, or their non-parametric equivalents (Mann-Whitney U test and Fisher’s exact test, Kruskall-Wallis) were used for statistical comparisons between groups and time periods.
Results: A total of 23108 children (46.7% female) were diagnosed with T1D at a mean age of 7.9±5 years. The age at diagnosis and the distribution of patients across age groups (i.e., <5 years, 5-10 years and >10 years) remained stable over time. There was no significant increase in diagnoses in very young children (<5 years) (all P>0.05). DKA occurred in 39.1% of participants, with 43.2%, 36.1% and 39.5% in children <5, 5-10 and >10 years respectively. Between 2010 and 2019, the incidence of DKA remained consistently high in all years (36.7%±1.7%), with 12.9%±0.9% of children presenting with severe DKA (P>0.05). In participants without a first-degree relative (FDR) with T1D, DKA increased significantly after the COVID-19 pandemic (2016-2019 vs 2020-2023) from 39.7% to 46.5% (P<0.0001). This was accompanied by a significant increase in severe DKA (14.1% to 19.6%, P<0.00001). Children with FDR (n=2523) had a lower rate of DKA than children without FDR (18.8% vs. 41.6%, P<0.000001), but severe DKA persisted at diagnosis in 6.3% of this group.
Conclusion: Over the past decade, the age at diagnosis of T1D has remained stable. The incidence of DKA remains stable and elevated, with almost half of children with new-onset T1D who do not have an FDR presenting with DKA. While the rate of DKA was significantly lower in children with a FDR, there were still cases of severe DKA in this group. Increasing awareness for pediatric DKA is thus mandatory.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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