Loading ...

Diagnosis of diabetic ketoacidosis is common in Latin American children with newly diagnosed type 1 diabetes. Diabetic ketoacidosis is observed in up to 61% of new diagnoses, and 36% are classified as severe. It occurs more frequently at younger ages in patients with lower body mass index (BMI) and in those without medical insurance.

"Diabetic ketoacidosis is a critical condition that should not be underestimated as it has the potential to progress to a diabetic coma and even death. It is an acute complication of diabetes that is often caused by delays in the diagnosis of type 1 diabetes and lack of awareness about the disease," Valeria Hirschler, MD, a pediatrician specialized in nutrition and diabetes, coordinator of the epidemiology committee of the Argentine Diabetes Society, and lead author of the research, told the Medscape Spanish edition.

The retrospective study, published in Journal of Pediatric Health Care, involved 30 specialized pediatric care centers in Argentina, Chile, and Peru. The methodology provided information on 2026 participants aged between 6 months and 18 years (women, 983; median age, 9.12 years) who were diagnosed with type 1 diabetes between 2018 and 2022.

The frequency of diabetic ketoacidosis at diagnosis was 60.7% (n = 1229), and 36% (n = 447) of cases were classified as severe. The prevalence was higher at younger ages, with rates of 70% in children aged < 6 years and 47.5% in those aged > 12 years. Lower BMI and lack of medical insurance were independent risk factors for these events.

"As far as we know, there are no major studies in Latin America that have analyzed the frequency and severity of diabetic ketoacidosis at the onset of type 1 diabetes," wrote the authors of the study, emphasizing the importance of better understanding these complications in the region.

Lack of Diabetes Education

Mabel Ferraro, MD, a pediatrician specialized in nutrition and diabetes and director of the pediatric physician nutritionist postgraduate program at the Faculty of Medicine of the University of Buenos Aires, Argentina, considered the research significant. Ferraro was not involved in the study. "Firstly, [it is significant] because it is a study conducted in Latin America, where publications are not as frequent as in the so-called central countries, such as the United States or some European countries. Additionally, it is a multicenter study, and the participating centers are renowned and experienced in the field."

Ferraro expressed great concern about the results because the reported prevalence of diabetic ketoacidosis in the region is much higher than in European countries such as Sweden (19%), Denmark (21%), Norway (22%), and Germany (20%).

"For our patients to debut with diabetic ketoacidosis, a serious and life-threatening situation, someone did not realize it before. That is, a child began with weight loss, thirst, and frequent urination, and someone did not notice," said Ferraro.

She urged healthcare professionals who care for children to consider type 1 diabetes during pediatric consultations. There is a need for greater education about the disease among the population, she said.

"First, we must think about diabetes in order to diagnose it. We must consider the cardinal symptoms and some risk factors highlighted in the article, for example, younger age. I think that is a very important message of this research," said Ferraro.

She emphasized that avoiding diabetic ketoacidosis from the beginning is important for the subsequent evolution of diabetes. "It is known that patients who do not debut with ketoacidosis have better pancreatic reserve. This ensures fewer long-term complications and a more stable form of diabetes."

The effectiveness of campaigns aimed at raising awareness about diabetes among healthcare professionals and the general population has been proven by other studies, leading to earlier diagnoses, better clinical management, and prevention of diabetic ketoacidosis episodes. For these reasons, the authors of the article also consider the implementation of such initiatives crucial in Latin America.

"The proactive commitment of doctors, nurses, and healthcare professionals can help Latin American families quickly recognize the symptoms of diabetes, thus avoiding diabetic ketoacidosis and the need for hospitalization. There is a need to increase awareness to prevent delays in diagnosis, especially among younger children from economically disadvantaged backgrounds," said Hirschler.

Public Health Investment

Another interesting finding from the research is that children with medical insurance had a lower frequency of diabetic ketoacidosis: 58.8% compared with 62.7% among those without medical coverage. In addition, severe episodes were less common in the former group (19.3% compared with 24.0%).

Socioeconomic inequalities contribute to increasing the prevalence of diabetic ketoacidosis, according to the researchers. Such complications are more common in contexts with lower educational levels, lack of medical insurance, and unemployment.

Ferraro shared experiences during the socioeconomic crisis that Argentina faced in 2001. "In our country, there were centers like the Pedro de Elizalde Hospital that saw an increased frequency of debut in diabetic ketoacidosis during that year."

In the research period analyzed, 50% of participants had medical coverage, but 86% were assisted in various public centers in the countries involved.

The authors noted that in Latin America, children have access to healthcare, even without medical insurance. Through the public healthcare system, they can receive regular and free diabetes management. However, those with medical coverage have the additional option of being treated at private healthcare facilities. Among other benefits, they tend to have greater access to advanced medications.

Typically, children in the region have medical insurance through their parents' stable employment, which may be lacking for some during economic crises. This underscores the importance of equal access opportunities through public health, according to the authors.

Ferraro stressed the importance of implementing educational programs for the general population to improve the concerning results related to diabetic ketoacidosis. In addition, she highlighted the need to enhance access to healthcare for children. Nonetheless, she sees the high percentage of patients with diabetes seeking care at public centers, even with medical insurance, as a step towards prioritizing public health in the region.

"I would tell health policy decision-makers that the greater the economic difficulties and the more deficiencies in a population, the more severe the clinical situations associated with diseases will be. What we have at our disposal is to not miss out on health opportunities, reach out to the population with fewer resources through educational programs, and of course, be vigilant," Ferraro concluded.

Hirschler and Ferraro declared no relevant financial relationships.

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.