Characterisation of diabetic ketoacidosis in children and adolescents with type 1 diabetes: a regional hospital study.

Aim: To characterise the clinical and biochemical parameters of children (0-16 years) who presented with Diabetic Ketoacidosis (DKA) at a regional hospital in Australia.

Methods: A retrospective observational study was conducted following the approval of the Ethics Committee. Data from 2018 to 2022 were collected from medical records, with a focus on patient treatment and follow-up.

Results: A total of 72 type 1 diabetes (T1D) patients with 30 DKA presentations were identified. The mean age at DKA presentation was 11.9 +/- 3.2 years, with 42.1% having new-onset T1D. An equal number of patients presented with mild (50%) and moderate to severe DKA. Of these, 24 presentations were managed with insulin infusion, and 6 (20%) were managed with subcutaneous insulin. Following a mean ED stay of 7.93 +/- 4.8 h, 14 patients (93.3%) were transferred to the CCU or ward, and 2 were transferred to a tertiary centre. The mean HbA1c was 12.55 +/- 2.1%, with a mean recovery time of 10.4 h for pH and 6.4 h for bicarbonate. Minor complications occurred in 10% of patients (all on insulin infusion). All patients were discharged in stable condition after 2.15 +/- 1.3 days. The follow-up rate was 72.2% (13/18), with a mean HbA1c of 8.32 +/- 1.8%.

Conclusion: Regional hospitals witness a high frequency of children with T1D presenting with DKA as their first presentation. Targeting bicarbonate levels for acidosis correction could help facilitate an earlier transition to subcutaneous insulin and needs due consideration. This study substantiates the use of upfront subcutaneous insulin for mild to moderate DKA with good outcomes. Follow-up care remains a crucial gap that necessitates strengthening regional diabetes management teams.

Clinical trial number: Not applicable.