Risk factors of first diabetes ketoacidosis in children and adolescents with type 1 diabetes
Keywords:
type 1 diabetes, auditory brainstem response, risk factors of recurrent seizures within 24 hours, HbA1cAbstract
Background: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D).
Objectives: To study risk factors of first diabetes ketoacidosis after diagnosis in children and adolescents with T1D
Methods: Retrospective cohort study was conducted in children and adolescents, aged 1-20 years, with T1D who received care at diabetes clinic from 1 January 2014 to 31 October 2024. The data were retrieved from medical records. Kaplan-Meier curve and log rank test were used to compare time to develop DKA. Multivariate cox proportional hazard model was used to identify risk factors of first DKA.
Results: A total of 120 patients are included in this study. Fifty-nine patients (49.2%) developed DKA during care. BMI z-score (AHR 0.52, 95%CI: 0.35, 0.78), HbA1c (AHR 1.21, 95%CI: 1.04, 1.41), basal bolus vs conventional/modified regimen (AHR 0.33, 95%CI: 0.15, 0.70) and regular vs non regular follow up (AHR 0.42, 95%CI: 0.18, 0.96) were significant risk factors of first DKA in T1D. Overall median time to DKA was 39 months (95%CI: 30.0, 44.5). The cumulative 1 and 3 years survival rates were 84.1 % and 74.5%, respectively. The rate of DKA-free survival within 3 years for patients with HbA1c ≤ 9% and HbA1c > 9% were 97.3% (95% CI: 92.2, 100) and 65.4% (95% CI: 55.8, 76.7), respectively. The difference between these groups was statistically significant (p value <0.001)
Conclusion: Low BMI z-score, high HbA1c level, conventional/modified regimens and lack of follow-up were significant risk factors for the first episode of DKA after diagnosis in T1D. To prevent DKA event, basal bolus regimen, regular follow up and monitoring HbA1c frequently were recommended including closed observe in patient with low BMI z-score and high HbA1c.
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