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Genetic screening, follow-up may decrease DKA at diabetes diagnosis
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The frequency of diabetic ketoacidosis precipitating diagnosis of type 1 diabetes in children may be decreased with genetic screening and follow-up for the disease, according to study findings published in Pediatric Diabetes.
Anne M. Hekkala, MD, PhD, of the department of pediatrics at the University Oulu in Finland, and colleagues evaluated children born at Oulu University Hospital since 1995 who were diagnosed with type 1 diabetes when they were younger than 15 years by 2015 (study cohort 1; n = 517) and all children diagnosed with type 1 diabetes younger than 15 years from 2002 to 2014 (study cohort 2; n = 579). Since 1995, newborns in the region have been recruited to be assessed for genetic risk for type 1 diabetes by screening for human leukocyte antigen (HLA) in umbilical cord blood. Researchers sought to determine the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and whether participation in screening follow-up studies decreased the risk for DKA.
In study cohort 1, overall frequency of DKA was 17.6%, and the frequency of severe DKA was 3.5% at the diagnosis of type 1 diabetes; 55.7% had been screened for HLA-conferred risk. Participants with an increased genetic risk who were followed in a prospective diabetes study had the lowest frequency of DKA at diagnosis (5%) compared with participants without HLA-screening (22.7%), participants with HLA-conferred risk but no follow-up (23.4%) and participants without HLA-conferred risk (26.7%; P < .001).
In study cohort 2, DKA was present at diagnosis for 18.5% of participants and severe DKA for 3.5%. Increasing age at diagnosis increased the frequency of DKA (13% in participants aged < 5 years; 14% in participants aged 5-9 years; 28.6% participants in participants aged 10-14 years; P < .001), and severe DKA was most frequent in older participants (6.9% in participants aged 10-14 years vs. 2.2% in participants aged < 5 years and 1.5% in participants aged 5-9 years; P = .008).
“Participation in the cord blood screening to detect increased HLA-conferred risk for [type 1 diabetes] without any follow-up did not have any effect on the frequency of DKA at diagnosis of [type 1 diabetes],” the researchers wrote. “Instead, children who had increased genetic susceptibility for [type 1 diabetes] and participated in prospective follow-up studies had very infrequently DKA at diagnosis. Overall, during 2002 to 2014 the frequency of DKA at diagnosis of [type 1 diabetes] was low among children aged below 10 years, and particularly in those under 2 years in Finland in the region where prospective birth cohort studies aimed at prediction and prevention of [type 1 diabetes] are ongoing. In the future, more attention should be paid to adolescents to make earlier diagnosis of [type 1 diabetes] and prevent DKA at disease presentation.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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