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Francisco Branco Caetano1, Ana Lança2, Cláudia Rodrigues3, Ana Margarida Garcia1, Sofia Bota1, Catarina Diamantino4, Ana Laura Fitas4, Júlia Galhardo4, Rosa Pina4, Lurdes Lopes4, Catarina Limbert4

1 – Área de Pediatria Médica, Centro Hospitalar Universitário de Lisboa Central - Hospital Dona Estefânia
2 – Serviço de Pediatria, Hospital de S. Francisco Xavier
3 – Serviço de Pediatria, Centro Hospitalar de Leiria
4 – Unidade de Endocrinologia Pediátrica, Centro Hospitalar Universitário de Lisboa Central - Hospital Dona Estefânia

- European Association for the study of Diabetes, Poster

Background and aims: The rate of diabetic ketoacidosis (DKA) in new-onset type 1 Diabetes mellitus (T1D) depends on multiple factors and is very heterogeneous between countries. There seems to be an inverse correlation between DKA’s frequency and T1D’s incidence. DKA has been reported to be more common among young children, especially under two-years old. Current data on Portuguese pediatric DKA’s incidence in new onset T1D is limited. We aimed to analyze clinical and biochemical data in order to determine the rate of DKA and associated risk factors in pediatric new onset T1D.
Methods: Retrospective descriptive analysis of collected data from pediatric patients at T1D onset, referred to a level III hospital between January 1st, 2013 and December 31th, 2019 (7 years). Paired and unpaired Student t test and 2-tailed Fisher exact test were used; a p value of 0.05 was considered significant.
Results: We included 228 children and adolescents with a mean age of 9,3 years (0,9 – 17,9 years, SD± 4,2 years): 15,4% aged between 2 and 5 years old and 3,5% under two years. A mean incidence of 33 new cases per year was observed, with an upward trend up until 2017. Comparing 2013 to 2019, new onset T1D cases under 5 years old more than doubled (n=3 vs. n=7).  Of all children and adolescents, 11,4% had a positive family history of T1D. Children were more frequently diagnosed after 2-4 weeks of clinical symptoms.Eighty-four children and adolescents (38,7%) presented with DKA, which was considered severe in 17 (20% of DKA cases); in 14 (6,1%), admission to the intensive care unit was needed. 41 children and adolescents (18%) presented only with hyperglycemia. DKA at presentation was more frequent in the age group under 2 years old (p=0,023 figure 1). The incidence of DKA was of 23% in 2013 and remained stable thereafter (36,6-40,9%). When considering children aged 5 years or older, a higher HbA1c value correlated with DKA at presentation (p=0,041).Non-DKA presentation was associated with a family history of T1D (p=0,015).
Conclusion: This retrospective analysis shows an upward trend in T1D’s incidence in children under 5 years old and a high DKA rate at disease onset, which was more frequent in patients under 2 years of age; severe DKA was present only in 7,5% of patients. Previous campaigns targeting parents, schools and primary healthcare professionals have been able to reduce DKA’s incidence in other countries. It is urgent to promote an earlier diagnosis through the implementation of educational programs, in order to improve awareness for pediatric T1D. This data may not be representative of the whole national landscape. Broader studies need to be conducted in order to draw wider conclusions.