Acid problem common at diabetes diagnosis in kids
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When first diagnosed with diabetes, roughly one in four children and teens in the US have a potentially life-threatening condition that makes their blood more acidic than normal, according to a report in the journal Pediatrics.
Known as diabetic ketoacidosis, the condition occurs when insulin levels in the body are so low that virtually no sugar is able to enter cells and provide energy. As a result, the body begins breaking down fat for energy, but this leads to the build-up of acidic chemicals called ketones into the blood. Symptoms include nausea, vomiting, stomach pain, chest pain, rapid shallow breathing, and trouble staying awake. Coma and even death can occur if the problem is not addressed expeditiously.
The key finding is that in the United States close to 30 percent of children with type 1 diabetes and 10 percent of those with type 2 diabetes have potentially life-threatening ketoacidosis at the time of diagnosis. “We expected lower rates, given the recent increase in community recognition of childhood diabetes and improvements in treatment,” lead author Dr. Arleta Rewers told Reuters Health.
“While poverty, barriers in access to care and lower parental educational attainment further increase the risk, over 20 percent of children from the most affluent families are diagnosed in ketoacidosis,” Rewers, a researcher with the University of Colorado at Denver, added.
The Search for Diabetes in Youth Study involved 3,666 patients who were diagnosed with diabetes before 20 years of age in selected US study areas from 2002 to 2004. A medical record review was conducted for 2,824 of the patients to determine the presence of ketoacidosis using standard diagnostic criteria.
Overall, 25.5 percent of subjects had ketoacidosis when they were diagnosed with diabetes, the report indicates. The proportion decreased with older age, ranging from 37.3 percent in children younger than 5 years to 14.7 percent in 15- to 19-year-olds.
About half of the patients were hospitalized at diagnosis. The proportion of patients hospitalized was much higher for those with ketoacidosis compared with patients without the condition: 93 versus 41 percent.
On further analysis, risk factors for ketoacidosis at diagnosis were lower family income, less desirable health insurance coverage, and lower parental education, the report shows.
“In light of the increasing incidence of diabetes in the U.S. and worldwide, a high index of suspicion on the part of parents and health care providers may reduce the rates of ketoacidosis and the cost of initial diabetes care,” Rewers said. “Early recognition of the (three classic diabetes symptoms) of increased thirst, urination, and hunger with weight loss is essential.”
SOURCE: Pediatrics, May 2008.
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