Endocrine Abstracts

Introduction: Paediatric diabetic ketoacidosis (DKA) is a serious complication of Type 1 diabetes mellitus (T1DM), presenting significant morbidity and mortality risks. The identification of factors associated with DKA would play an important role in directing resources and efforts at effective preventive strategies.

Objectives: To describe the prevalence and factors associated with DKA in patients with diabetes from April 2021-22 and April 2022-23 in Royal Preston Hospital.

Methods: We carried out retrospective analyses of data from patients with type 1 diabetes who presented with DKA from April 2021 to March 2023 and factors associated with DKA were described.

Results: From 2021-22, there were 20 patients (Male=11 Female=9) with 27 DKA admissions. From 2022-23 there were 23 patients, (Male=11 Female=12) with 28 DKA admissions. The prevalence of DKA were 8.7% and 9.2% respectively. Their mean ages were 11.81 (SD=4.16) and 12.45 (SD 3.83) respectively with range of 2-17 years. In 2021-22 and 2022-23 respectively, 25% and 30% of patients had previous episodes of DKA and (74% vs 65%) were admitted in mild to moderate DKA. The mean HbA1c was 80 mmol/mol in all patients. In 2021-22, 60% of those with DKA were newly diagnosed and 32% in 2022-23. Factors associated with DKA in 2021-22 and 2022-23 were poor compliance (30% and 54%), presence of illness (5% and 7%), social concerns (48% and 25%) respectively and 40% of patients were receiving Psychology support. In 2021-22, 73% wore continuous glucose monitoring (CGMS), 1 patient was on insulin pump and 48% were on multiple daily injections (MDI), while in 2022-23, 83% wore CGMS, 3 were on insulin pump and 57% were on MDI.

Conclusion: Significant factors associated with DKA presentation were new diagnosis, social concerns associated with poor compliance despite the use of CGMS in over 70% of the patients. Therefore, future work should focus on improving training and awareness of primary care health care providers and parents on early recognition of symptoms of diabetes. In addition, provision of social and psychological support with intensive education would be of great benefit in improving glycaemic control and reducing incidence of DKA and its comorbidity in these patients.