Frequency and clinical characteristics of ketoacidosis at onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia

OBJECTIVE: To determine the frequency, and to describe the clinical characteristics of ketoacidosis at initial diagnosis of childhood type 1 diabetes mellitus (T1DM) in Al-Madina region of the Northwest province of Saudi Arabia.

METHODS: We retrospectively analyzed the hospital records of 311 (152 males and 159 females) children diagnosed with childhood T1DM in Al-Madina region, Saudi Arabia between January 1992 and December 2004.

RESULTS: At diagnosis 172 (55.3%) children presented with diabetic ketoacidosis at the onset of their illness, 101 (58.7%) were females and 71 (41.3%) males. We found females to have more ketoacidosis at the onset of their illness with 1.4:1 female to male ratio. The mean age at presentation with ketoacidosis was 6.7 years (95% CI=5.6-7.8) ranging from 4 months to 14 years. Most of the ketoacidosis was mild to moderate (84.9%), while only 26 (15.1%) children had the severe type. Sixty-one (35.5%) children were in the younger age group, 54 (31.4%) were in the middle age group, and 57 (33.1%) were in older age group, there was no significant difference (p=0.5) between the 3 age groups in the frequency of ketoacidosis. The duration of symptoms before presentation with ketoacidosis was 15.8 days (95% CI=13.5-18.1). Altered consciousness was present in 21 (12.2%) children; all of them were from the severe type of ketoacidosis. There was a strong correlation between the severity of the central nervous system depression and the degree of acidosis (r=0.826, p<0.0001), but no correlation with age, gender, duration of symptoms, and blood glucose level.

CONCLUSION: The frequency of ketoacidosis at onset of childhood diabetes mellitus in our region is significant. Prevention of diabetic ketoacidosis and reduction of its frequency should be a goal in managing children with diabetes. Rising standards of medical information and general awareness can contribute to this.