For Debate: Paediatric T1DM: DKA is Still a Problem.

Although the treatment of pediatric patients with T1DM has improved ketoacidosis (DKA) remains a frequent problem. OBJECTIVE: To estimate temporal changes in the prevalence of DKA at diagnosis of T1DM and to explore the factors associated with its occurrence. METHODS: Paediatric patients diagnosed at Cruces University Hospital (Spain) since 1997 were included. Clinical/analytical variables at diabetes onset, Hemoglobin A1c level during the first 2 years of evolution and the presence of the honeymoon phase were studied. RESULTS: In 209 patients the prevalence of DKA was stable over time and high (35.4%) especially in the youngest. 8.5% of patients had a severe DKA with a higher risk in older than 10. Partial remission occurred in 26% patients, less frequent in the youngest and in the subgroup with DKA at diagnosis. CONCLUSION: The frequency of DKA although stable, remains high and is associated with a worse evolution of the disease.