Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents
Diabetes & Metabolism. 2014-04-01; 40(2): 137-142
DOI: 10.1016/j.diabet.2013.11.001
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1. Diabetes Metab. 2014 Apr;40(2):137-42. doi: 10.1016/j.diabet.2013.11.001. Epub
2013 Dec 11.
Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents.
Choleau C(1), Maitre J(2), Filipovic Pierucci A(3), Elie C(3), Barat P(4),
Bertrand AM(5), de Kerdanet M(6), Letallec C(7), Levy-Marchal C(8), Nicolino
M(9), Tubiana-Rufi N(10), Cahané M(11), Robert JJ(2); AJD Study Group.
Collaborators: Abdelhadi M, Ajzennman C, Amira R, Badet E, Baechler-Sadoul E,
Barakat I, Baron S, Beltrand J, Bengrina M, Bensignor C, Blanc P, Boniface C,
Bornebusch L, Bortoluzzi MN, Bouhours-Nouet N, Boulard S, Boussadia H, Braun K,
Briffaut D, Brintet I, Chambon M, Chergui A, Chevrel J, Cloix I, Colin-Gorski AM,
Cottancin G, Coupe B, Cuvelier ML, Dalla-Vale F, Daltroff G, de Meneix E, Demayer
N, Deniau F, Depret G, Derquenne H, Desgranges V, Deshayes C, Dieckmann K,
Ducrocq S, Dufillot D, Dumont C, Duquesne JP, Durand C, Durand MF, Druon D, Faure
N, Favaretto G, Ferré P, Ferrer V, Flament F, Fournier S, Gajdos V, Gallois B,
Garrec N, Gastaud F, Geneste B, Georget E, Gilles I, Gonin K, Goumy P, Gourdin A,
Grando A, Greco M, Gronnier P, Guemazi-Kheffi F, Guerin B, Guillem C, Guilly O,
Guitteny MA, Hoffmann G, Huin N, Hureaux A, Idres N, Jalloul M, Jellimann S,
Jossens A, Joubert F, Kauffmann D, Kerouedan C, Khoury J, Kozisek S, Kurtz F,
Labay F, Lagarde F, Lahrach H, Laisney N, Laplane D, Laurent-Atthalin B, Layadi
M, Lecomte D, Lemerle S, Lienhardt-Roussie A, Loeuille GA, Louf S, Lucidarme N,
Maire V, Mangin D, Mansilla M, Martel C, Martineau L, Mathivon L, May A, Memiche
D, Mignot B, Mignot C, Milleret-Proyart MJ, Mochon S, Monteil S, Moreigne M,
Morin C, Moulène E, Muller S, Musial-Salmon AS, Nadif S, Nicolescu R, Nold B,
Orze-chowski C, Pantalone L, Parlier G, Pecheur H, Perdereau S, Popelard F,
Questiaux E, Raverdy C, Razafimahefa B, Ricard R, Richard O, Rougeoreille C,
Rouget S, Saade JP, Sarraf N, Simonin G, Staumont H, Stuckens C, Tahiri C,
Tamboura A, Teissier R, Thévenieau D, Terral D, Tixier F, Tronc F, Valade A,
Vautier V, Vervel C, Wemeau C, Wieliczko MC, Zimmermann B.
Author information:
(1)Aide aux jeunes diabétiques, 9, avenue Pierre-de-Coubertin, 75013 Paris,
France. Electronic address: .
(2)Aide aux jeunes diabétiques, 9, avenue Pierre-de-Coubertin, 75013 Paris,
France; Diabète de l’enfant et de l’adolescent, université
René-Descartes-Sorbonne-Paris-Cité, hôpital Necker-Enfants Malades, AP-HP, Paris,
France.
(3)Service de biostatistique, université René-Descartes-Sorbonne-Paris-Cité,
hôpital Necker-Enfants Malades, Paris, France.
(4)Endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, Bordeaux, France.
(5)Unité d’endocrinologie – diabétologie pédiatriques médecine pédiatrique, CHU
Jean-Minjoz, Besançon, France.
(6)Endocrinologie et diabétologie pédiatriques, hôpital Sud, CHU de Rennes,
Rennes, France.
(7)Diabétologie pédiatrique, pôle pédiatrique, CHU de Toulouse, Toulouse, France.
(8)Inserm CIC EC 05, hôpital Robert-Debré, Paris, France.
(9)Endocrinologie pédiatrique, hôpital femme-mère-enfant, université de Lyon,
Lyon, France.
(10)Endocrinologie et diabétologie pédiatriques, université Paris-Diderot,
Sorbonne-Paris-Cité, hôpital Robert-Debré, AP-HP, Paris, France.
(11)Aide aux jeunes diabétiques, 9, avenue Pierre-de-Coubertin, 75013 Paris,
France.
OBJECTIVES: This study aimed to evaluate the frequency of diabetic ketoacidosis
(DKA) and its associated factors at the diagnosis of type 1 diabetes (T1D) in
French children and adolescents prior to launching a public-health campaign of
information to prevent DKA.
PATIENTS AND METHODS: Over a 1-year period, 1299 youngsters (aged < 15 years)
were diagnosed with T1D at 146 paediatric centres in all regions of France. Age,
gender, duration of symptoms, patient's pathway to diagnosis, clinical and
biological signs, and family history of T1D were collected for each newly
diagnosed patient. DKA was defined as pH < 7.30 or bicarbonate < 15 mmol/L, and
severe DKA as pH < 7.10 or bicarbonate < 5 mmol/L.
RESULTS: At the time of diagnosis, 26% of the children were aged 0-5 years, 34%
were 5-10 years and 40% were 10-15 years. The overall prevalence of DKA was 43.9%
(0-5 years: 54.2%; 5-10 years: 43.4%; and 10-15 years: 37.1%) and 14.8% for
severe DKA (0-5 years: 16.6%; 5-10 years: 14.4%; and 10-15 years: 13.9%; < 2
years: 25.3%). Severe DKA was more frequent when the child was hospitalized at
the family's behest (26.6%) than when referred by a general practitioner (7.6%)
or paediatrician (5.1%; 30.6%, 53.7% and 9.2%, respectively, by patients' age
group). The frequency of DKA decreased to 20.1% (severe DKA: 4.4%) in families
with a history of T1D. Multivariate analysis showed that age, pathway to
diagnosis, duration of polyuria/polydipsia (< 1 week) and family history of T1D
were associated with the presence of DKA, while pathway to diagnosis and family
history of T1D were associated with severe DKA.
CONCLUSION: DKA at the time of T1D diagnosis in children and adolescents is
frequent and often severe. Patients' age, pathway to hospitalization and family
history of diabetes were the main factors associated with DKA. These data suggest
that a public-health campaign to prevent DKA at diagnosis can help reduce the
frequency of DKA and also provide baseline data for evaluating the efficacy of
such a campaign.
Copyright © 2014. Published by Elsevier Masson SAS.
DOI: 10.1016/j.diabet.2013.11.001
PMID: 24332018 [Indexed for MEDLINE]