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Diabetic Ketoacidosis Forecasts Inferior Long-Term Diabetes Management

Diabetic Ketoacidosis Forecasts Inferior Long-Term Diabetes Management

Key Takeaways

  • Diabetic ketoacidosis (DKA) is a very serious condition that leads to diabetic coma or even leads to death.
  • Having tight glycemic control in patients is important for preventing long-term diabetes complications.
  • The outcomes show that children who presented with DKA were younger, Hispanic or nonwhite (ethnic minorities), health insured by the government or uninsured, and less likely to have first-degree relatives with type 1 diabetes unlike those presenting without DKA.

Recognizing early signs of type 1 diabetes is crucial in the early prevention of diabetic ketoacidosis (DKA). Diabetic ketoacidosis (DKA) is a very serious condition that leads to diabetic coma or even leads to death. A recent research published online was carried out by Lindsey M Duca, PhD, at the Barbara Davis Center for Diabetes and the University of Colorado, Aurora. It revealed that children who had diabetic ketoacidosis during type-1 diabetes diagnosis were at a high risk for poor long term glycemic control.

Glycemic control refers to the levels of glucose (blood sugar) in a person living with diabetes mellitus (DM). Glycemic control is still substandard for a number of patients diagnosed with type 1 diabetes. Long-term complications of diabetes results from many years of hyperglycemia.

A study published online to determine the Factors Predicting Glycemic Control in Type 1 Diabetic Patient, DCCT and the follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) suggested that proper glycemic management over a long period slows the onset as well as slowing the progression of microvascular and macro vascular complications in those who have type 1 diabetes. The method used involves the study of 188 patients who had diabetes type 1 and who showed several factors related to the disease. The results were a negative correlation between the age at diabetes onset and HbA1c value (p=0.02). Results show that youths had higher HbA1c value (10.8±2.9%) compared to adults (9.2±2.8%, p=0.02). There was no relationship found between the average HbA1c value and the number of daily insulin injections. Results reveal that average HbA1c was increased in patients with a lack of compliance (11.1±3.3%) to insulin therapy (8.9±2.4%, p<0.0001), in people with under 3 clinic visits each year (10.7±3.5% vs. 9.0±2.1%, p=0.001), in patients having lipohypertrophy (10.9±2.5% vs. 9.2±3.4%, p=0.008) and in people who have celiac disease (14.5±5.2% vs. 9.6±2.9%, p=0.005).

The research study concluded that there are several aspects relating to poorer glycemic control in type 1 diabetes patients. These factors include the age when the patient developed the disease and how long they had it, schedule of the insulin treatment, dedication to insulin therapy, the act of self-monitoring and more. Good glycemic control leads to better treatment of diabetes. This phenomenon of studying glycemic control in the body is an important goal of diabetes care. But what happens when a patient is diagnosed with DKA? Having tight glycemic control in patients is important for preventing long-term diabetes complications. Moreover, patients with DKA may need closer long-term monitoring.

Insight: How DKA Foresees Poorer Control

Research carried out by Lindsey M Duca, PhD involves 3364 people who reside in Colorado with T1D diabetes aged 0 to 17 during 1998 to 2012 monitored up to 17 years. Out of the 3364 kids, 1297 (38.6 %) were with DKA at diagnosis. HbA1c was measured about 2.8 times per year with median 20 HbA1c values/patient. Another model that was linear mixed was also used as a way to study how DKA affected long-term HbA1c levels with adjustment for health insurance, a family history of the disease, race or ethnicity, age, sex as well as the use of an insulin pump.

The severity of DKA was classified as mild or moderate (with pH 7.10-7.29) or severe (with pH <7.10) research team also used bicarbonate where 5-14mEq/L for moderate and <5mEq/L for severe DKA. The outcomes show that children having DKA were younger, Hispanic or nonwhite (ethnic minorities), health insured by the government or uninsured, and were not as likely to have immediate relatives that have type 1 diabetes unlike those presenting without DKA compared. Adjustment for those factors and other confounders, shows HbA1 tracked 1.4% (15.3 mmol/mol) higher for those with severe DKA and 0.9% (9.8 mmol/mol) higher for those who had mild/moderate DKA compared with those without (which shows P<.0001 for both).

Furthermore, independent of ethnic minority status as well as a lack of insurance predicted higher value ofHbA1C by 5.5 mmol/mol and 2.2 mmol/mol or 0.5 and 0.2 percentage points respectively. With those adjustments, having DKA when diagnosed predicts worse control as it was clear in nearly 40% of cases.

What might be the reason? Research writers predict an increase in the severity of beta-cell loss by hyperglycemia and inflammation. As such, diabetic ketoacidosis may impair cognitive function (which encompass reasoning, attention, memory, and language) leading to diminished self-care capacity (a measure designed to sustain and regain health).

As said by Arleta Rewers, MD, who is a doctor at University of Colorado's department of pediatrics, the effects of DKA can last more than 15 years as shown by their long term implications of DKA, which had persisted for at least 15 years depicted from the data records and research they carried out. Furthermore, Dr. Arleta Rewers also noted that the most crucial and urgent clinical need is early recognition of diabetes symtpoms. This includes accessing polydipsia, polyuria as well as weight loss. Moreover, it is also necessary to institute insulin treatment in order to prevent diabetic ketoacidosis.

This research has a great impact for a call to further push for universal screening of pediatric type 1 diabetes.

Why the Need for This?

Universal Pediatric Screening for type 1 diabetes was proposed in 2015 by JDRF and ADA for a three-stage classifying approach. This model, as the joint research statement suggests "will aid the development of therapies and the design of clinical trials to prevent symptomatic disease and promote precision medicine," as published in Diabetes Care.

As the model isn’t advisable for clinical use, this approach provides a framework which helps show the risk/benefit of regulatory, reimbursement, and clinical-care settings as stated by JDRF chief scientific officer Richard A Insel and his fellow researchers.

Other experts have shown concern by justifying the need for screening for DKA prevention. Reason being that people would be more aware of the possible risk and seek quick action as early as the first symptoms of hyperglycemia.

As a program to push this awareness, a program sponsored by Barbara Davis Center and Autoimmunity Screening for Kids and cosponsored by JDRF and Helmsley Charitable Trust screened 2500 healthy kids from Denver between the ages of 2 to 17 for pancreatic islet and celiac antibodies. Since then, 1 in 30 kids from the program had been identified being at risk for either of two autoimmune conditions. To keep watch, there would be complete findings presented at the October International Society for Pediatric and Adolescent Diabetes meeting.

The focus of this presentation as per Dr. Marian Rewers is to be able to discuss the need for the establishment of a routine screen of young kids that should be covered by health insurance plans. This would be greatly beneficial in controlling and treatment of diabetes. As at stake now, DKA Independently Predicts Worse Control which when such screening is implemented, there would be better diagnosis and control of DKA as research and findings suggest.

In conclusion, the bottom line from this research shows that effective prevention of Diabetic ketoacidosis at diagnosis is important as it may provide enduring benefits towards improving long-term glycemic control.