Evaluating the Impact of Acute Kidney Injury and Diabetic Ketoacidosis on Subsequent HbA1c in the First 36 Months in Children and Adolescents With New-Onset Type 1 Diabetes Mellitus.

Background: Children and adolescents with new-onset Type 1 Diabetes Mellitus (T1D) experience high rates of both Acute Kidney Injury (AKI) and Diabetic Ketoacidosis (DKA). However, their relative impact on subsequent HbA1c is not well understood.

Objectives: To evaluate the relative effects of DKA and AKI on HbA1c levels within the first 36 months following diagnosis.

Methods: Data was collected from a cohort of all children and adolescents presenting to a regional paediatric diabetes centre with new onset T1D between 2006 and 2016.

Results: 585 children were included, with a mean age of 8.9 years (SD 3.8) at diagnosis. 257 children (44%) had AKI, classified as 181 (70%) KDIGO stage 1, 61 (24%) stage 2, and 15 (6%) stage 3. 167 children (29%) presented with Diabetic Ketoacidosis (DKA). Overall, AKI at diagnosis was not associated with HbA1c at any time point. However, more severe AKI was associated with lower HbA1c at 6 months (p = 0.04). DKA at diagnosis was linked to higher HbA1c levels at 6, 12, and 24 months (p < 0.05), but there was no difference at 36 months.

Conclusions: Although both AKI and DKA are common at diagnosis in children and adolescents with T1D, it is DKA at diagnosis that is associated with higher HbA1c levels in follow-up. This highlights the importance of efforts to identify T1D early and prevent DKA. While more severe AKI was linked to lower HbA1c levels 6 months after diagnosis, replication is required in other cohorts.