High Risk of Diabetic Ketoacidosis With Diabetes Presentation in Infancy

HealthDay News — Diabetes in infancy has different characteristics depending on mutation subtype, and is associated with high frequency of diabetic ketoacidosis (DKA), according to a report published in Diabetes Care.

Lisa R. Letourneau, MPH, RD, from the University of Chicago, and colleagues examined diagnosis records from 88 cases with diabetes onset ≤13 months of age. The authors assessed laboratory values and sign/symptoms, and subdivided participants by similar mutation subtypes among those with a causal mutation for diabetes.

The researchers found that the most common form of infancy-onset diabetes was KCNJ11-related diabetes (37.5%), followed by “unknown” (likely type 1 diabetes; 21.6%); transient neonatal diabetes occurred in 14%. 

The median age at diagnosis of diabetes was 10.4 weeks; age at diagnosis differed significantly by mutation subtype. Diagnosis age was significantly lower in the transient diabetes group vs the permanent group (median, 15.2 vs 0.43 weeks). Polyuria, tachypnea, flu-like symptoms, tiredness/weakness, dehydration, and “not acting right” were the most commonly reported signs/symptoms. Blood glucose, pH, bicarbonate, hemoglobin A1c, and DKA were dependent on the subtype of mutation. The frequency of DKA was 66.2% overall, and increasing age at diagnosis correlated with increased odds of DKA (odds ratio, 1.23 per 1 month increase).

“Continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis,” the authors write.

The study was funded by a grant from Novo Nordisk.

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Letourneau LR, Carmody D, Wroblewski K, et al. Diabetes presentation in infancy: high risk of diabetic ketoacidosis. Diabetes Care. 2017 Oct;40(10):e147-e148