Endocrine Abstracts

Introduction: Type 1 diabetes is an Autoimmune disease which usually presents in metabolic decompensation with absolute insulin deficiency. Presentation can vary from mild osmotic symptoms to severe Diabetes ketoacidosis (DKA). We have observed a recent increase of incidence of severe DKA. The aim of this audit was to assess the relationship between severity of presentation and body mass index.

Methodology: A descriptive cohort study was undertaken in 55 children (male=23, female=27) who presented to our emergency department between Jan 1^st -Dec 1^st 2023 with the first episode of Diabetes and were clinically diagnosed as Type 1 Diabetes.

Results: 38.18% (n = 21) presented with severe DKA (pH < 7.1) whilst 10.3%(n = 6) had mild to moderate DKA. Seven required intensive care treatment with one death due to tonsillar herniation. Other associated complications were peripheral neuropathy with nerve conduction abnormalities (n = 2), persistent myopathy with electromyography abnormalities (n = 1), cerebral haemorrhages and new onset epilepsy(n = 1). Four patients who presented with severe DKA had been assessed in primary care for the same complaints. Of those presenting with severe DKA, seven (36.8%) even had a family history of type 1 diabetes. Median BMI centile was 52.3 (IQR 38.6- 91). 40.4%(n = 17) were overweight or obese. Median presenting HbA1c was 105 mmol/mol (IQR 91-125). There was no significant association between severity of DKA and body mass index (BMI), (P = 0.5668). 81.5%(n = 44) belonged to the two most deprived quintiles (1-2) and 63.6% were of non-white ethnicity.

Conclusion: Rate of initial presentation in DKA in our centre is twice as high as the UK average of 1 in 4 This might reflect high levels of socio-economic deprivation and additional challenges through ethnic diversity. We were unable to demonstrate an association between Obesity and presentation in DKA, but this might be related to levels of Obesity and overweight in the general population. Our data demonstrate the urgent need for developing novel strategies to raise awareness of symptoms of type 1 diabetes tailored for ethnic diverse and socioeconomic deprived communities.