Endocrine Abstracts

Background: The majority of children and young people (CYP) with Type 1 and Type 2 diabetes mellitus (DM) present with diabetic ketoacidosis (DKA) at diagnosis. Presentation in DKA has been associated with younger age, socio-economic deprivation, ethnic background, and absence of a family history of DM.

Aim: To describe the clinical and epidemiological characteristics of children presenting with newly diagnosed DM at one of the largest tertiary referral centres in Sri Lanka.

Methodology: A retrospective cohort study was conducted using case notes of all children with new-onset DM registered between January and December 2022 at the Lady Ridgeway Hospital for Children, Colombo, Sri Lanka.

Results: Fifty-six children (19 males, 37 females) with newly diagnosed DM were included. The mean age at presentation was 9.75 years (range 1.5–14.75years). Fourteen children (25%) presented in DKA: mild-5 (8.9%), moderate-3 (5.4%), and severe- 6 (10.7%). The median duration of symptoms was 14 days (range 2 days-1year). The most common symptoms at presentation were polyuria (94.5%), polydipsia (92.7%), and weight loss (92.7%). Only two children presented with impaired consciousness. Acanthosis nigricans was noted in 11 children. Children whose fathers had completed tertiary education experienced a significantly shorter mean symptom duration before admission compared to those whose fathers had only primary education (9.67 vs. 46 days, P = 0.02). Although not statistically significant, a similar trend was observed with maternal education (14 vs. 39 days for tertiary vs. primary/ordinary level education). Age, ethnicity, family history of DM, parents’ education level and distance from the local hospital were not significantly associated with the risk of DKA at presentation.

Conclusion: The incidence and severity of DKA in this cohort are comparable to data from developed countries, with most cases being mild to moderate. Parental education—particularly paternal tertiary education resulted in earlier healthcare seeking behaviour and significantly shorter duration of symptoms before diagnosis.