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... more
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
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We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0–18 years: DKA (pH <... more
We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0–18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records(n=2453)of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n=1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all...
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RIASSUNTO La chetoacidosi diabetica (diabetic ketoacidosis, DKA) è una complicanza del diabete di tipo 1, particolarmente grave quando si manifesta nei bambini; se non diagnosticata e trattata ade-guatamente può associarsi a edema... more
RIASSUNTO La chetoacidosi diabetica (diabetic ketoacidosis, DKA) è una complicanza del diabete di tipo 1, particolarmente grave quando si manifesta nei bambini; se non diagnosticata e trattata ade-guatamente può associarsi a edema cerebrale, danno neurolo-gico permanente e può perfino mettere a rischio la vita del paziente. Fino a oggi gli studi su questo fenomeno in Italia sono stati molto limitati. Nel periodo gennaio-maggio 2014, nell'ambito del GdS di Dia-betologia Pediatrica, è stata effettuata un'indagine osservazio-nale retrospettiva sulla DKA all'esordio, su base nazionale, che ha coinvolto complessivamente 76 centri. La DKA è stata definita mediante i criteri dell'ISPAD. Sono stati esaminati 7457 casi di diabete di tipo 1 di nuovo esordio nella popolazione dell'Italia Pe-ninsulare e Sicilia e 770 della Sardegna, diagnosticati nel decen-nio 2004-2013. Nella prima popolazione in media la DKA era presente all'esordio nel 32,9% dei casi (intervallo di co...
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Research Interests: Endocrinology, Adolescent, Medicine, Growth Hormone, Humans, and 15 moreChild, Internal Medicine, Insulin, Female, Clinical, Male, Growth hormone deficiency, Clinical Sciences, Bone Marrow Transplantation, Adult, Blood Transfusion, Body Height, Clinical Endocrinology, Beta Thalassemia, and Clonidine
In line with the global obesity epidemic, a raised weight gain has been described in children and adolescents with type 1 diabetes mellitus (T1DM) [1, 2]. The waist-to-height ratio (W/h), a proxy measure of central fat distribution, has... more
In line with the global obesity epidemic, a raised weight gain has been described in children and adolescents with type 1 diabetes mellitus (T1DM) [1, 2]. The waist-to-height ratio (W/h), a proxy measure of central fat distribution, has been proposed as a simple and useful tool to detecting, among overweight children, those with a higher likelihood of having cardiometabolic risk [3]. Since the distribution of overweight in the general population in Italy varies among different geographic areas and shows the highest prevalence in the south [4], we explored whether the frequency of abdominal adiposity and consequently of metabolic syndrome (MetSy) also varied across the different geographic areas in Italian adolescents with T1DM. This cross-sectional study included a total of 412 Italian adolescents of Caucasian origin (219 males) with T1DM, aged 16–19 years, with a duration of diabetes of 8.4 ± 3.9 years. They were recruited from 18 care referral centers for diabetes in childhood affiliated to the Study Group on Diabetes of the Italian Society of Paediatric Endocrinology and Diabetology. Anthropometry, blood pressure, and venous fasting blood samples tested for triglycerides and HDL cholesterol were measured; HbA1c values (mean of four determinations during the previous year) were mathematically standardized to the DCCT normal range. All patients were on multi-injection or pump insulin treatment; the daily insulin dose (ID) per body surface area was calculated. MetSy was defined according to the IDF criteria; all patients were considered to fulfill the criterion of hyperglycemia. Communicated by Renato Lauro.