J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-42650 | DOI: 10.4274/jcrpe.galenos.2024.2024-6-4

Hospital Admission for Diabetic Ketoacidosis in Thai Children and Adolescents with Type 1 Diabetes: A National Study during 2015-2019

Somboon Wankanit¹, Kaewjai Thepsuthammarat², Preamrudee Poomthavorn¹, Taninee Sahakitrungruang³, Pat Mahachoklertwattana^1
1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
²Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
³Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

INTRODUCTION: To study the national incidence of admission for diabetic ketoacidosis (DKA) in Thai children and adolescents with type 1 diabetes (T1D) and characterize risk factors for DKA admission.
METHODS: Admission records of children and adolescents with T1D during the years 2015-2019 were retrieved from the Thai health coverage system of all schemes. Hospitalization was categorized according to patients’ age groups (<1, 1-5, 6-12 and 13-17 years), sex and geographical regions (Bangkok, Central, Northeast, North and South). DKA admission incidence and rate were calculated and compared among subgroups.
RESULTS: The annual incidences of T1D and DKA admissions progressively increased over the study period (T1D: 12.0 to 15.0, p<0.001 and DKA: 4.8 to 7.3 per 100,000 child-years, p<0.001). About half of DKA admissions (52%) were recurrent episodes. DKA admission rate was 1.49 admissions/patient. The incidence of DKA admission was greatest in individuals aged 13-17 years (13-17 years: 10.3; 6-12 years: 6.3; 1-5 years: 1.7; and <1 year: 0.6 per 100,000 child-years, p<0.001). DKA admission incidence was greater in females than males (7.6 vs. 4.3 per 100,000 child-years, p<0.001). Among 5 geographical regions, greatest percentage of recurrent DKA (57%), rate of increased annual incidence of DKA admission (3.8 to 7.8 per 100,000 child-years), and DKA admission rate (1.64 admissions/patient) were found in the Northeast region.
DISCUSSION AND CONCLUSION: During the years 2015-2019, rising annual incidences of T1D and DKA admissions among Thai youth were observed. Individuals older than 6 years, being females, and resided in the Northeast region had higher risk for DKA hospitalization.

Keywords: Diabetic ketoacidosis, type 1 diabetes, hospitalization, children, adolescent

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