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Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children

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Abstract

Aims

Diabetic ketoacidosis (DKA) at diabetes diagnosis is a dangerous yet potentially preventable condition. Young age, low socioeconomic status, and low parental education have been found to be associated with increased risk of DKA. We aimed to evaluate the impact of religious affiliation on presentation with DKA at type 1 diabetes mellitus (T1DM) diagnosis in Jewish children.

Methods

The study comprised an analysis of medical records of all consecutive patients with new-onset T1DM who were admitted to one tertiary medical center from January 2007 to January 2014. DKA was defined as venous pH <7.3 or HCO3 − < 15 mmol/l, and severe DKA as pH <7.1 or HCO3 − < 5 mmol/l.

Results

Of 81 patients with new-onset T1DM (38 females, mean ± SD age at diagnosis 9.9 ± 4.2 years), 34 (42 %) presented with DKA: 21 of 60 (35 %) of patients from secular families and 13 of 21 (62 %) from ultra-orthodox families. Children from ultra-orthodox families had a 3.5-fold increased risk of presenting with DKA than children from secular families (95 % CI 1.2–10.1, p = 0.02) and a 3.8-fold risk to be admitted with severe DKA (95 % CI 1.1–12.6, p = 0.02). Other factors that were found to be associated with an increased risk of DKA were younger age, an absence of maternal academic education, and residence in an area of low socioeconomic status.

Conclusions

DKA and severe DKA at diabetes diagnosis were more common among religious ultra-orthodox than among secular Jewish children. Awareness of the symptoms and dangers of DKA in new-onset T1DM should be directed to particularly high-risk population groups.

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Abbreviations

DKA:

Diabetes ketoacidosis

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

MODY:

Maturity-onset diabetes of the young

SES:

Socioeconomic status

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Acknowledgments

We thank Dana Hadar, MSc, The Women and Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University for a statistical assistance, and to Valentina Boyko, MSc, The Women and Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University for a thorough statistical analysis. We thank Cindy Cohen, MA, for an editorial assistance.

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Human and animal rights disclosure

This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent disclosure

Due to the retrospective nature of the analysis, informed consent was not obtained, with approval of the Institutional Review Board.

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Authors and Affiliations

  1. Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel

    Noah Gruber & Orit Pinhas-Hamiel

  2. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Noah Gruber, Brian Reichman, Liat Lerner-Geva & Orit Pinhas-Hamiel

  3. The Women and Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel

    Brian Reichman & Liat Lerner-Geva

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  1. Noah Gruber
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Correspondence to Noah Gruber.

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Gruber, N., Reichman, B., Lerner-Geva, L. et al. Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children. Acta Diabetol 52, 365–371 (2015). https://doi.org/10.1007/s00592-014-0653-4

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