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Microbiota, epidemiological and nutritional factors related to ketoacidosis at the onset of type 1 diabetes

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Abstract

Aims

The incidence of type 1 diabetes has increased over the last decades. The pathological pathway is not yet clear, even if genetic and environmental risk factors are known. An early diagnosis can avoid ketoacidosis and its complications. This work aims to discuss the determinants of both ketoacidosis at the onset and access by hospital emergency departments without a suspected diagnosis.

Methods

An observational bi-centric prospective study was conducted in Northern Italy, on a paediatric population including Italian and migrant patients at the diabetes onset. Seventy-four type 1 diabetes patients, both Italian and migrant, were included in the study. Anthropometric, socio-economic, behavioural, clinical data were collected, and microbiota analyses were performed using stool samples.

Results

Regular physical activity is associated with lower ketoacidosis incidence at onset (OR 0.33 95% CI 0.12–0.95 p < 0.05), as is higher blood vitamin D level (OR 0.92 95% CI 0.85–0.99 p < 0.05). Moreover, a higher weaning age (OR 0.49 95% CI 0.27–0.89 p < 0.05), higher vitamin D level (OR 0.90 95% CI 0.83–0.98 p < 0.05) and a higher level of Akkermansia muciniphila (OR 0.46 95% CI 0.25–0.87 p < 0.05) are associated factors to lower frequency of type 1 diabetes onset without a suspected diagnosis. Diabetes migrant status is not a risk factor for severe type 1 diabetes onset; on the other hand, some protective factors are significantly more diffused among Italians, such as regular sport activity and non-critical vitamin D levels.

Conclusion

Behavioural and nutritional data, such as microbiota bio-indicators, seem to be useful to identify an at-risk population to prevent ketoacidosis and its severe complications.

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Acknowledgements

The authors wish to thank the Italian Ministry of Health for funding (RF-2011-02350617), Dr. Barbara Di Stefano (Sanitary Direction AOU Novara), as well as Mrs. Rim Maatoug, Mrs. Shpresa Xheka and Mrs. Daniela Elena Zelinschi, cultural intermediaries at the Novara Hospital, for the translation of the questionnaire for migrant people. Finally, the authors especially acknowledge the participating children and their families.

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Authors and Affiliations

  1. Department of Public Health and Pediatrics, University of Study of Torino, Piazza Polonia 94, 10126, Turin, Italy

    Deborah Traversi, Giacomo Scaioli, Giulia Carletto, Irene Masante, Franco Cerutti & Roberta Siliquini

  2. S.S.V.D. Endocrinologia E Diabetologia, O.I.R.M., A.O. Città Della Salute E Della Scienza Di Torino, Turin, Italy

    Ivana Rabbone, Camilla Vallini & Franco Cerutti

  3. Department of Health Science, UPO University A.O.U., ‘‘Maggiore Della Carità’’, Novara, Italy

    Ivana Rabbone, Francesco Cadario, Silvia Savastio & Deborah Carrera

  4. S.C.U Medicina Interna 3, Molinette Hospital, Città Della Salute E Della Scienza Di Torino, rin, Italy

    Marilena Durazzo, Alessandro Collo, Paola Belci & Arianna Ferro

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  1. Ivana Rabbone
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Rabbone, I., Traversi, D., Scaioli, G. et al. Microbiota, epidemiological and nutritional factors related to ketoacidosis at the onset of type 1 diabetes. Acta Diabetol 57, 1337–1349 (2020). https://doi.org/10.1007/s00592-020-01555-z

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