Background: Diabetes mellitus type ۱ is one of the most prevalent endocrine diseases in pediatrics. Diabetic ketoacidosis is considered as one of the most threatening clinical pictures of DM۱, especially if occurred as the first presentation of DM۱ in children.
Objectives: The current study aimed to identify factors which may play a role in DKA onset in children.
Methods: This case-control study included all patients under ۱۸ years old who referred to department of pediatrics endocrinology at Mashhad University Hospital (Imam Reza) from January ۲۰۱۳ to December ۲۰۱۵ as newly diagnosed patients with DM۱. Patients who fulfilled DKA criteria at diagnosis were considered as DKA group and those who referred with other presentations were considered as control group (non-DKA group). Data were analyzed by SPSS software ver. ۱۶.
Results: During the study period, ۹۷ (۳۹.۲% male) newly diagnosed patients were included as DKA group. Accordingly ۹۷ gender- and age-matched patients were added as non-DKA group. The most prevalent symptoms in both groups were polyuria (۹۱.۸۸%) and polydipsia (۸۸.۶۶%). Fever and cold symptoms were significantly higher in the DKA group (P < ۰.۰۰۱ and P =۰.۰۰۵, respectively). Hemoglobin A۱c level was significantly higher in the DKA group (P = ۰.۰۰۱), while body mass index was significantly lower in the DKA group (P = ۰.۰۴۵). Fever and father’s education level were the most important risk and protective factors in the DKA onset in newly diagnosed patients with DM۱ (adjusted OR = ۱۰.۱, ۹۵% CI = ۲.۹-۳۵.۳; P < ۰.۰۰۱ and adjusted OR = ۰.۵, ۹۵% CI = ۰.۳ - ۰.۹ and P = ۰.۰۱۹, respectively).
Conclusions: In conclusion, a recent febrile illness was found as the strongest risk factor and father’s education level as the main protective factor in the DKA to diagnose children with DM۱. The study findings suggested that DKA is a severe form of DM۱ instead of a neglected or misdiagnosed disease.