GIDM. GIORNALE ITALIANO DI DIABETOLOGIA E METABOLISMO
Abstract
Ketoacidosis is a potentially life-threatening complication in patients
with type 1 diabetes mellitus (T1DM), particularly children.
If diabetic ketoacidosis (DKA) is diagnosed late, the child risks
cerebral edema, permanent neurological damage or even death.
There have been only few studies of DKA in Italy.
From January-May 2014 a nation-wide observational, retrospective
study of DKA at diabetes onset was done by the Pediatric
Diabetology Study Group (PDSG) of the Italian Society of
Pediatric Endocrinology and Diabetes (ISPED), involving 76 Italian
centers. DKA was defined using ISPAD criteria; 7457 new cases
of T1DM were recruited from mainland Italy and the island of Sicily
and 770 from Sardinia, in the period 2004-2013. On the mainland
and in Sicily, DKA at diabetes onset was about 32.9% (95%
CI 31.8-34.0%), and there was 6.6% (95% CI 6.02-7.20%) of the
severe form. Mild and severe DKA risk was significantly higher in
children aged 0-4 years; no significant temporal trend was found
in the study period. Patients living in Sardinia or having a firstdegree
relative with T1DM were at significantly lower risk of DKA
at diabetes onset. In the ten-year study period three children died
of DKA at onset and four suffered permanent neurological lesions.
From November 2011-April 2012 the PDSG conducted a retrospective
study based on a sample of 2025 patients with T1DM,
aged 0-18 years, involving 29 national centers for pediatric diabetes.
The incidence of DKA was 2.4% (IC 95% 1.8-3.1), with
children older than ten years at significantly higher risk, probably
due to shortages of insulin. Multiple analysis showed a higher risk
of DKA in those using a rapid-acting insulin analog and in those
with high HbA1c. Young mothers and low levels of education were
also associated with DKA.
In conclusion, although a wide network of specialized home pediatricians
and pediatric diabetes centers is spread across the country,
the incidence of DKA at diabetes onset is still high. Further social
and health-system efforts are needed to boost awareness of this
risk and to reduce damages and costs related to the complication.
