Type 1 diabetes onset in children and adolescents: Clinical and temporal analysis in a tertiary referral center

Abstract

Background

Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in pediatric patients with type 1 diabetes mellitus (T1DM). The objectives of this study were to analyze the incidence of DKA at the time of T1DM diagnosis and to evaluate changes in its presentation over recent years. We also assessed whether a family history of T1DM or specific HLA haplotypes influenced the incidence of DKA at diagnosis.

Materials and methods

We conducted a descriptive, observational, and retrospective study of all patients younger than 14 years diagnosed with T1DM at a tertiary referral center from from 2017 through 2024. Data collected included age at onset, sex, date of diagnosis, and initial laboratory values. Data were, then, grouped into 2 periods of time (2017–2020; 2020–2024) for comparison purposes.

Results

A total of 85 patients were included (41 women), with a mean age at diagnosis of 7.9 years. DKA at disease onset was observed in 29 patients (34.1%), including 15 cases (17.6%) classified as severe. Mean C-peptide level was 0.8 ng/mL, mean plasma glucose level was 423 mg/dL, and mean hemoglobin A1c level was 11.1%.

Between 2017 and 2020, 37 new diagnoses were established, 37.8% with DKA (13.5% severe) and from 2021 to 2024, 48, 31.2% with DKA (20.8% severe).

A total of 12 patients had first-degree relatives with T1DM, and 0 exhibited DKA (P < .05). No significant associations were found between HLA haplotypes and the incidence rate of DKA.

Conclusions

The prevalence of DKA at diagnosis was similar to that reported in other Spanish studies. Having a family history of T1DM seems to be a protective factor against the development of DKA. No significant association was found between HLA haplotypes and DKA prevalence.

Resumen

Introducción

La cetoacidosis diabética (CAD) constituye la principal causa de morbimortalidad en pacientes pediátricos con Diabetes Mellitus tipo 1 (DM1).

Nuestros objetivos fueron analizar la incidencia de CAD al diagnóstico de DM1 y los cambios en la presentación en los últimos años. Asimismo, se evaluó si tener familiares con DM1 o determinados haplotipos HLA influía en la incidencia de CAD.

Material y métodos

Estudio descriptivo, observacional y retrospectivo que incluyó a todos los menores de 14 años diagnosticados de DM1 en un hospital de tercer nivel entre 2017-2024. Se registraron edad al debut, sexo, fecha de diagnóstico y datos analíticos iniciales. Posteriormente, los datos se agruparon en dos periodos temporales (2017-2020; 2021-2024) para su comparación.

Resultados

Se incluyeron 85 pacientes (41 mujeres), edad media 7,9 años. Veintinueve (34,1%) presentaron CAD al debut, de los cuales 15 (17,6%) fueron graves. El péptido C medio fue 0,8 ng/mL, la glucemia media 423 mg/dL y la HbA1C 11,1%.

Entre 2017-2020 se registraron 37 debuts, 37,8% con CAD (13,5% grave). Entre 2021-2024, 48 de los que 31,2% presentaron CAD (20,8% grave).

Doce pacientes tenían familiares de primer grado con DM1 y ninguno debutó con CAD (p < 0,05). No se encontraron asociaciones significativas entre los haplotipos HLA y la incidencia de CAD.

Conclusión

La incidencia de CAD al diagnóstico fue similar a la descrita en otros estudios españoles. Tener antecedentes familiares de DM1 parece actuar como factor protector frente al desarrollo de CAD. No se halló asociación entre haplotipos HLA y prevalencia de CAD.