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Does diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus predict poorer long-term glycemic control

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus.

Aims

This study aimed to determine (1) whether DKA at diagnosis of type 1 diabetes is associated with poorer long-term glycemic control and (2) whether there are confounding factors which may impact the mode of presentation of type 1 diabetes mellitus or subsequent glycemic control.

Methods

This study was conducted via review of 102 patient files extracted from the Young Person’s Type 1 Diabetes Clinic at Cork University Hospital. Glycemic control was measured using the average of the patient’s three most recent HbA1C levels, recorded a median of 11 years post-diagnosis of type 1 diabetes mellitus.

Results

Data analysis revealed a positive association between DKA at diagnosis and poorer long-term glycemic control, with HbA1c levels tracking 6.58 mmol/mol (0.6%) higher at follow up in the group with DKA compared to the group without DKA at diagnosis. Certain sociodemographic factors were found to predict worse glycemic control at follow-up: Individuals using recreational drugs and those reporting mental health difficulties were found to have higher levels of HbA1C at follow up (p = ·006,·012, respectively) compared to individuals who did not.

Conclusions

Diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus was shown to be associated with poorer long-term glycemic control in this study. Furthermore, individuals who utilize recreational drugs or have mental health difficulties had significantly worse glycemic control at follow-up.

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Abbreviations

DKA:

Diabetic ketoacidosis

CSII:

Continuous subcutaneous insulin infusion

HbA1C:

Hemoglobin A1C

References

  1. Rewers A, Dong F, Slover RH et al (2015) Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth 1998–2012. JAMA 313:1570–1572

    Article  PubMed  Google Scholar 

  2. Usher-Smith J, Thompson M, Sharp S et al (2011) Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 343(jul07 1):d4092-d4092

  3. Pawlowicz M, Birkholz D, Niedzwiecki M et al (2009) Difficulties or mistakes in diagnosing type 1 diabetes in children? Demographic factors influencing delayed diagnosis. Pediatr Diabetes

  4. Cameron F, Scratch S, Nadebaum C et al (2014) Neurological consequences of diabetic ketoacidosis at initial presentation of type 1 diabetes in a prospective cohort study of children. Diabetes Care 37(6):1554–1562

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gibb F, Teoh W, Graham J et al (2016) Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia 59(10):2082–2087

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Komulainen J, Lounamaa R, Knip M et al (1996) Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group. Arch Dis Child 75(5):410–415

  7. Fernandez Castañer M, Montaña E, Camps I et al (1996) Ketoacidosis at diagnosis is predictive of lower residual beta-cell function and poor metabolic control in type 1 diabetes. Diabetes Metab 22(5):349–355

    PubMed  Google Scholar 

  8. Fernández Castañer M, Gonzálbez J, Carrera MJ et al (1997) The influence of clinical presentation and metabolic control of insulin dependent diabetes in the evolution of residual insulin secretion. A prospective study at five years. Med Clin 109:328–332

  9. Bowden S, Duck M, Hoffman R (2008) Young children (<5 yr) and adolescents (>12 yr) with type 1 diabetes mellitus have low rate of partial remission: diabetic ketoacidosis is an important risk factor. Pediatr Diabetes 9(3pt1):197–201

  10. Abdul-Rasoul M, Habib H, Al-Khouly M (2006) “The honeymoon phase” in children with type 1 diabetes mellitus: frequency, duration, and influential factors. Pediatr Diabetes 7(2):101–107

    Article  PubMed  Google Scholar 

  11. Mortensen H, Swift P, Holl R et al (2009) Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis. Pediatr Diabetes 11(4):218–226

    Article  Google Scholar 

  12. Duca L, Reboussin B, Pihoker C et al (2018) Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: the SEARCH for diabetes in youth study. Pediatr Diabetes 20(2):172–179

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fredheim S, Johannesen J, Johansen A et al (2013) Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels. Diabetologia 56(5):995–1003

    Article  CAS  PubMed  Google Scholar 

  14. Duca L, Wang B, Rewers M et al (2017) Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 40(9):1249–1255

    Article  CAS  PubMed  Google Scholar 

  15. Shalitin S, Fisher S, Yackbovitch-Gavan M et al (2017) Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control. Pediatr Diabetes

  16. Pinkney J, Bingley P, Sawtell P et al (1994) Presentation and progress of childhood diabetes mellitus: a prospective population-based study. Diabetologia 37(1):70–74

    Article  Google Scholar 

  17. Sassa M, Yamada Y, Hosokawa M et al (2008) Glycemic instability in type 1 diabetic patients: possible role of ketosis or ketoacidosis at onset of diabetes. Diabetes Res Clin Pract 81(2):190–195

    Article  CAS  PubMed  Google Scholar 

  18. Shalitin S, Phillip M (2011) Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age? Acta Diabetol 49(5):355–362

  19. Salardi S, Zucchini S, Cicognani A et al (2003) The severity of clinical presentation of type 1 diabetes in children does not significantly influence the pattern of residual beta-cell function and long-term metabolic control. Pediatr Diabetes 4(1):4–9

    Article  PubMed  Google Scholar 

  20. Nathan DM, Genuth S, Lachin J et al (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329(14):977–986

  21. Mental health in Ireland: awareness and attitudes (2017) [cited 29 December 2017]. Available from: http://www.healthpromotion.ie/hp-files/docs/HSP00612.pdf

  22. Blanz B, Rensch-Riemann B, Fritz-Sigmund D et al (1993) IDDM is a risk factor for adolescent psychiatric disorders. Diabetes Care 16(12):1579–1587

    Article  CAS  PubMed  Google Scholar 

  23. Butwicka A, Frisén L, Almqvist C et al (2015) Erratum. Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study. Diabetes Care 38:453–459

  24. Gonzalez J, Peyrot M, McCarl L et al (2008) Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31(12):2398–2403

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee P, Greenfield J, Gilbert K et al (2012) Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control? Intern Med J 42(2):198–202

    Article  CAS  PubMed  Google Scholar 

  26. Hogendorf A, Fendler W, Sieroslawski J et al (2016) Breaking the taboo: illicit drug use among adolescents with type 1 diabetes mellitus. J Diabetes Res 2016:1–8

    Article  Google Scholar 

  27. Ng R, Darko D, Hillson R (2003) Street drug use among young patients with type 1 diabetes in the UK. Diabet Med 21(3):295–296

    Article  Google Scholar 

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Funding

Irish Endocrine Society Summer Student Bursary 2017.

Summer Undergraduate Research Experience Award 2017.

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Authors and Affiliations

  1. University College Cork, Cork, Ireland

    Louise Kelly & Antoinette Tuthill

  2. Department of Diabetes and Endocrinology, Cork University Hospital, Cork, Ireland

    Louise Kelly & Antoinette Tuthill

Authors
  1. Louise Kelly
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  2. Antoinette Tuthill
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Contributions

LK and AT planned the study. LK carried out the data collection and data analysis and wrote the manuscript. LK and AT took part in drafting the article or revising it for critically important intellectual content, and the authors gave final approval of this version to be submitted.

Corresponding author

Correspondence to Louise Kelly.

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Ethical approval

This study was approved by the Research Ethics Committee of the Cork Teaching Hospitals (CREC) and conforms to the recognized ethical standards of same.

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The authors declare no competing interests.

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Kelly, L., Tuthill, A. Does diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus predict poorer long-term glycemic control. Ir J Med Sci 192, 1703–1709 (2023). https://doi.org/10.1007/s11845-023-03345-2

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