O que crianças sabem sobre complicações agudas do diabetes? Insights para educação em diabetes / ¿Qué saben los niños sobre complicaciones agudas de diabetes? Perspectivas para la educación diabética / What children know about diabetes acute complications? Insights for diabetes education

Objective:to identify the knowledge and attitudes of school-agedchildren with diabetes facing acute complications.Method:exploratory study design with a qualitative approach, which used puppets as a data collection strategy. Children aged between seven and 12-years having experience with the disease for at least oneyear, followed-up at a Childhood Outpatient Clinic from Santa Catarina, Brazil, were interviewed. Analysis followed deductive content analysis. Results:participants demonstrated poor management of hyperglycemia episodes which could prevent diabetic ketoacidosis. The knowledge about hypoglycemia is higher due to its frequency; however, it has been the result of a deficient self-care with poor adult supervision. Conclusions:lack of understanding and inadequate management was evidenced, in especial, during the hyperglycemia and when the children are away from their parents. The nurses should promote education to immediate actions in acute complications. Educational materials focused on these clientele will contribute to enhance knowledge and abilities.

Objetivo:identificar conhecimentos e atitudes de crianças escolares com diabetes tipo 1 frente complicações agudas da doença. Método:estudo exploratório, qualitativo, que utilizou fantoches como estratégia de coleta de dados. Crianças entre 7 e 12 anos, com pelo menos um ano de diagnóstico, seguidas em ambulatório infantil de Santa Catarina, Brasil, foram entrevistadas. Análise de conteúdo dedutiva foi realizada. Resultados:participantes demonstraram pobre conhecimento e manejo dos episódios de hiperglicemia, o que poderia prevenir a cetoacidose diabética. Os conhecimentos sobre hipoglicemia são maiores, pois ocorrem com frequência, porém têm sido resultado de autocuidado deficiente com pobre supervisão de adultos. Conclusões:falta de entendimento e manejo inadequado das complicações foi evidenciado, em especial na hiperglicemia e quando longe dos cuidadores. O enfermeiro deve promover educação de crianças e famílias para ações imediatas e efetivas perante complicações agudas. Materiais educativos, direcionados a esta clientela, contribuirão para maior conhecimento e desenvolvimento de habilidades.

Objetivo:identificar conocimientos y actitudes de escolares con diabetes tipo 1 frente a las complicaciones agudas de la enfermedad. Método:estudio cualitativo exploratorio que utilizó títeres y fueron entrevistados niños entre 7 y 12 años, con al menos un año de diagnóstico, en una clínica infantil en Santa Catarina, Brasil. Se realizó un análisis de contenido. Resultados:hayescaso conocimiento y manejo de los episodios de hiperglucemia, lo que podría prevenir la cetoacidosis diabética. El conocimiento sobre la hipoglucemia es mayor, ya que ocurre con frecuencia, pero ha sido el resultado de un autocuidado deficiente con una supervisión adulta deficiente. Conclusiones:falta comprensión y manejo adecuado de las complicaciones, especialmente en la hiperglucemia y cuando está lejos de los cuidadores. El enfermero debe promover la educación de los niños y las familias para acciones inmediatas y eficaces frente a las complicaciones agudas. Los materiales educativoscontribuirán a esto.

Debut de diabetes tipo 1 en niños durante la pandemia Covid-19 en el Hospital de Pediatría Juan P. Garrahan / Debut of type-1 diabetes in children during the COVID-19 pandemic at Hospital de Pediatría Juan P. Garrahan

Introducción: Según numerosos reportes, la pandemia por COVID­19 aumentó la incidencia de diabetes tipo 1 (DBT1) y cetoacidosis (CAD). Nuestro objetivo fue describir la frecuencia de nuevos casos de DBT1 y su severidad al ingreso en el Hospital J. P. Garrahan durante la pandemia, comparando con el periodo anterior. Material y métodos: Se realizó un estudio descriptivo, observacional, con análisis retrospectivo. Se incluyeron todos los nuevos casos entre 19/03/20- 31/12/21, comparados con el período 19/03/18-31/12/19. El diagnóstico de DBT1, CAD y su severidad se realizó según la International Society for Pediatric and Adolescent Diabetes. Se analizó el requerimiento de cuidados intensivos (UCI), presencia de COVID-19, hemoglobina glicosilada A1C (HbA1C) y autoanticuerpos (GADA, IAA, IA2, ZNT8). Se consideró significativa una p < 0,05. Resultados: En el período 2020-2021 se observó un incremento del 107% de nuevos casos, ingresando 56 pacientes con DBT1. La media y mediana de edad disminuyeron (8 vs 9,1 y 7,7 vs 10,4, respectivamente), con un incremento del 35% de menores de 5 años. Aumentó la frecuencia de CAD severa (41.1% vs 25.9%) y de requerimiento de UCI (17.9% vs 11.1%). La Hb A1C y la glucemia de ingreso mostraron incremento significativo (10.1% vs 12.32%, p<0.003 y 580 mg/dl ± 220 vs 490 mg/dl ± 188; p<0.05, respectivamente). Conclusión: En 2020-2021 se incrementó el número de nuevos casos de DBT1 en nuestra institución. Al ingreso hubo mayor proporción de niños pequeños y casos severos. Las dificultades de acceso a la consulta de atención primaria podrían relacionarse con nuestro hallazgo (AU)

Introduction: Numerous reports have shown that during the COVID-19 pandemic the incidence of type-1 diabetes (T1DB) and ketoacidosis (DKA) increased. The aim of this study was to describe the frequency of new cases and their severity on admission of T1DB at Hospital J. P. Garrahan during the pandemic, compared with the previous period. Material and methods: A descriptive, observational study with a retrospective analysis was conducted. All new cases seen between 19/03/20-31/12/21 were included and compared with the period 19/03/18-31/12/19. The diagnosis of T1DB, DKA, and its severity was made according to the International Society for Pediatric and Adolescent Diabetes. Intensive care (ICU) requirement, presence of COVID-19, glycosylated hemoglobin A1C (HbA1C), and autoantibodies (GADA, IAA, IA2, ZNT8) were analyzed. A p < 0.05 was considered significant. Results: In the period 2020-2021, a 107% increase in new cases was observed including 56 patients with T1DB. Mean and median age decreased (8 vs 9.1 and 7.7 vs 10.4, respectively), with a 35% increase in children under 5 years of age. The frequency of severe DKA (41.1% vs 25.9%) and ICU requirement (17.9% vs 11.1%) increased. Hb A1C and glycemia on admission also showed a significant increase (10.1% vs 12.32%, p<0.003 and 580 mg/dl ± 220 vs 490 mg/dl ± 188; p<0.05, respectively). Conclusion: In 2020-2021 an increase in the number of new cases of T1DB was observed at our institution. On admission, a higher rate of young children and severe cases was found. Difficulties to access primary care may have been related to our finding (AU)

Cetoacidosis diabética como debut de diabetes mellitus inmunomediada en paciente en tratamiento con inhibidores de checkpoint / Diabetic ketoacidosis as debut of immune-mediated diabetes mellitus in a patient in treatment with immune checkpoint inhibitors

Los inhibidores de checkpoint (ICP) son anticuerpos usados en inmunoterapia contra el cáncer. Uno de sus blancos de acción es el receptor de muerte celular programada-1 (PD-1), el cual es importante para mantener la tolerancia inmunitaria. Sin embargo, este mecanismo se asocia a riesgo de eventos adversos relacionados a la inmunidad que pueden afectar a múltiples órganos incluyendo el sistema endocrino. Se describe el caso inhabitual de un paciente que a los 18 meses de terapia con ICP debutó con cetoacidosis diabética (CAD).

Immune checkpoint inhibitors consist in antibodies used in immunotherapy against cancer. One of their targets is the programmed cell death-1 (PD-1) receptor, which is important in maintaining self-tolerance. However, this mechanism is associated with a risk for immune-related adverse events potentially affecting multiple organs, including the endocrine system. We describe the unusual case of a patient who, after 18 months of treatment with an immune checkpoint inhibitor, debuted with diabetic ketoacidosis

Cetoacidosis diabética posterior a vacuna contra SARS-CoV-2: reporte de un caso / Diabetic ketoacidosis following SRS-CoV-2 vaccination: a one case report

Las emergencias hiperglicémicas como la cetoacidosis diabética (CAD) y el síndrome hiperglicémico hiperosmolar (SHH) se han descrito en el contexto de infección por SARS-CoV-2, como también secundarias a las múltiples vacunas desarrolladas contra el virus. La fisiopatología que explicaría esta asociación aún no está clara, pero existen diversas teorías que incluyen la destrucción directa de los islotes pancreáticos por el virus o secundario a mecanismos inmuno-inflamatorios. Presentamos el caso de un paciente que debutó con CAD al tercer día de la primera dosis de CoronaVac, y que posteriormente presentó hiperglicemia sin cumplir criterios de CAD luego de la segunda y tercera dosis de CoronaVac y Pfizer respectivamente. La temporalidad, como la falta de gatillante y la evolución del cuadro, apuntan a la vacuna como el principal precipitante. Por lo anterior, es importante mantener una vigilancia estricta de los efectos adversos de las vacunas y educar sobre los síntomas sugerentes de una crisis hiperglicémica para pesquisarla a tiempo y actuar oportunamente.

Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) have been reported in SARS-CoV-2 infections and after vaccination. The pathophysiology behind this association is still unclear, several theories have been described that include the direct destruction of the pancreatic islets by the virus, and some immuno-inflammatory mechanisms. We present the case of a patient who develope DKA the third day after the first dose of CoronaVac vaccine, and then hypergycemia after the second and third dose of CoronaVac and Pfizer repectively. The temporal relation, lack of a trigger and evolution of the disease, point the vaccine as the main precipitant. The strict surveillance of vaccines adverse effects and education of symptoms suggestive of hyperglicemic emergency are critical to prevent and treat promptly this kind of situations.

Psicologia e diabetes no Brasil: um mapeamento de profissionais e de suas ações / Psychology and diabetes in Brazil: the mapping of professionals and their practices / Psicología y diabetes en Brasil: un mapeo de los profesionales y sus acciones

Pouco se sabe sobre a atuação do psicólogo no Brasil junto a pessoas com Diabetes Mellitus. O objetivo desta pesquisa foi identificar os psicólogos brasileiros que trabalham com essa população e suas ações. Foram convidados a responder a um questionário online psicólogos que atuam ou atuaram junto a pessoas com diabetes. Participaram 79 psicólogos, principalmente da região Sudeste (59,5%). Todos declararam que haviam cursado pósgraduação. Na amostra, predominou o gênero feminino (89,9%), com idade entre 26 e 40 anos (46,8%). A maioria dos que atuam com diabetes declarou-se autônoma ou voluntária, e quase metade trabalhava menos do que 10 horas semanais. Entre aqueles que deixaram de trabalhar com diabetes, apenas uma minoria tinha vínculo empregatício. Além do trabalho com pessoas com diabetes, a maior parte declarou exercer outras atividades profissionais, como atendimentos clínicos em consultórios particulares, sugerindo que esta não é a atividade principal. Majoritariamente, os respondentes declararam não ter conhecimentos suficientes para o atendimento específico às pessoas com diabetes. Discute-se a qualidade da formação profissional dos psicólogos no Brasil, a necessidade de aprimoramento em relação à atuação com pessoas com diabetes e as condições de trabalho.(AU)

Little is known about the practice of psychologists in Brazil caring for people with Diabetes Mellitus. The aim of this research was to identify the Brazilian psychologists who work with this population and describe their actions. Psychologists who work or have worked with people diagnosed with diabetes were invited to answer an online questionnaire. The 79 participants lived mainly in the Southeast Region (59.5%). All of them declared to have a graduate degree, most were female (89.9%), aged 26 to 40 years (46.8%). Most of those working with diabetes declared to be autonomous or voluntary, and almost half had a workload of less than 10 hours a week. Among those who stopped working with diabetes, only a minority had a formal employment contract. In addition, most of them stated that they had other professional activities related to clinical care in private offices, suggesting that working with diabetes is not their main activity. Mostly, respondents stated that they did not have enough knowledge to care for people with diabetes. The quality of professional education of psychologists in Brazil, the need for specific improvement in labor relations and conditions were discussed.(AU)

Son escasas las informaciones del trabajo de los psicólogos en Brasil con las personas con Diabetes Mellitus. El objetivo de este estudio fue identificar los psicólogos brasileños que trabajan con esta población y describir sus acciones. Se invitó a psicólogos que trabajan o hayan trabajado con personas con diabetes a responder un cuestionario en línea. Participaron 79 psicólogos, principalmente de la región Sureste de Brasil (59,5%). Todos declararon tener posgrado. En la muestra hubo una mayor prevalencia del género femenino (89,9%), de edades de entre 26 y 40 años (46,8%). La mayoría de los que trabajan con personas con diabetes se declararon autónomos o voluntarios, y casi la mitad trabajaba menos de 10 horas a la semana. Entre los que dejaron de trabajar con las personas con diabetes, solo una minoría tenía una relación laboral. Además de trabajar con personas con diabetes, la mayoría afirmó tener otras actividades profesionales, como la atención clínica en consultorios privados, lo que sugiere que esta no es su actividad principal. La mayoría de los encuestados afirmaron que no tenían los conocimientos suficientes para atender específicamente a las personas con diabetes. Se discuten la calidad de la formación profesional de los psicólogos en Brasil, la necesidad de mejora en relación con el trabajo con personas con diabetes y las condiciones laborales.(AU)

Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Characteristics of children with newly diagnosed type 1 diabetes mellitus in Brunei Darussalam / Journal of the ASEAN Federation of Endocrine Societies

Objective@#This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger.@*Methodology@#A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam.@*Results@#A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p=0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0±14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018.@*Conclusions@#The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.

Prática clínica de enfermagem no manejo ao paciente crítico com cetoacidose diabética / Práctica clínica de enfermería en el manejo del paciente crítico con cetoacidosis diabética / Clinical nursing practice in the management of critically ill patients with diabetic ketoacidosis

Objetivo: Descrever as práticas realizadas por enfermeiros no manejo ao paciente crítico com cetoacidose diabética (CAD). Método: Revisão integrativa de literatura realizada entre maio e junho de 2022 nas bases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Banco de Dados de Enfermagem (BDENF) e Medical Literature Analysis and Retrievel System Online (MEDLINE/PubMed). Foram selecionados para esta revisão 08 artigos. Resultados: Os resultados apontam que o enfermeiro deve estar atento aos sinais e sintomas dos fatores precipitantes causadores da CAD e, entre os portadores, promover ações para o seu controle, por intermédio de medidas como monitoramento da glicemia e o desenvolvimento de atividades educativas para o autocuidado. Este profissional deve manter a observação de forma contínua durante o tratamento. Conclusão: A cetoacidose é uma emergência glicêmica no qual torna-se necessário que o profissional de enfermagem tenha conhecimentos fundamentais a respeito dos sinais e sintomas da CAD.(AU)

Objective: To describe the practices performed by nurses in the management of critically ill patients with diabetic ketoacidosis (DKA). Method: Integrative literature review carried out between May and June 2022 in the following bases: Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), Nursing Database (BDENF) and Medical Literature Analysis and Retrievable System Online (MEDLINE/PubMed). Eight articles were selected for this review. Results: The results indicate that nurses should be aware of the signs and symptoms of precipitating factors that cause CAD and, among patients, promote actions for its control, through measures such as blood glucose monitoring and the development of educational activities for the self care. This professional must maintain continuous observation during treatment. Conclusion: Ketoacidosis is a glycemic emergency in which it is necessary for the nursing professional to have fundamental knowledge about the signs and symptoms of DKA.(AU)

Objetivo: Describir las prácticas realizadas por enfermeros en el manejo de pacientes críticos con cetoacidosis diabética (CAD). Método: Revisión integrativa de la literatura realizada entre mayo y junio de 2022 en las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca Científica Electrónica en Línea (SciELO), Base de Datos de Enfermería (BDENF) y Sistema de Análisis y Recuperación de Literatura Médica en Línea (MEDLINE/ PubMed). Se seleccionaron ocho artículos para esta revisión. Resultados: Los resultados indican que los enfermeros deben ser conscientes de los signos y síntomas de los factores precipitantes que causan la EAC y, entre los pacientes, promover acciones para su control, a través de medidas como el monitoreo de la glucosa en sangre y el desarrollo de actividades educativas para el autocuidado. Este profesional debe mantener observación continua durante el tratamiento. Conclusión: La cetoacidosis es una emergencia glucémica en la que es necesario que el profesional de enfermería tenga conocimientos fundamentales sobre los signos y síntomas de la CAD.(AU)

COVID 19 y Diabetes Mellitus tipo 1 en la infancia. Cuba. Informe preliminar / Covid 19 and Diabetes Mellitus type 1 in childhood. Cuba. Preliminary report

Introducción: en diciembre de 2019 se inició una epidemia por coronavirus SARS-CoV-2, causante de un síndrome de dificultad respiratoria que, posteriormente, se denomina enfermedad COVID-19y que es probable afecta menos a los niños que a los adultos. En Cuba existen aproximadamente 15,246 contagiados menores de 19 años. La diabetes mellitus tipo 1 (DM1) asociada al COVID-19puede representar peligro para la vida del paciente. Objetivo: determinar algunas características de la COVID-19en la población pediátrica estudiada con diabetes mellitus tipo 1 durante el primer año de inicio de la pandemia en Cuba. Método: se seleccionaron al azar los servicios de endocrinología pediátrica de las provincias: Ciego de Ávila, Villa Clara, Pinar del Río y en La Habana (Hospitales Pediátricos Cerro y Centro Habana). Se solicitó cuántos pacientes durante el primer año de la pandemia (marzo 2020-marzo 2021) debutaron con DM1, cuántos en cetosis/cetoacidosis. Estos datos se compararon con el año 2019. Se investigó cuantos niños DM1 ingresaron con Covid 19. Resultados: existió incremento (57.3 %) de los pacientes con debut de DM1 durante el primer año de la pandemia en comparación con 2019. La presencia de cetosis/cetoacidosis aumentó (58.2 %). Se detectó cuatro pacientes con Covid 19 y DM1, (frecuencia baja: 0, 53 %). Conclusiones: el incremento de la DM1 y de cetosis/cetoacidosis pudiera estar relacionado indirectamente con la pandemia por Covid 19, ya sea por stress, confinamiento, alimentación inadecuada o la combinación de estos factores, es prudente tener un seguimiento a mediano y largo plazo de estos pacientes.

Introduction: On December 2019, an epidemic due to the SARS-CoV-2 coronavirus began, causing a respiratory distress syndrome, later it is called the COVID-19disease, it probably affects children less than adults. In Cuba, there are approximately 15,246 infected persons under 19 years of age. Type 1 diabetes mellitus (DM1) associated with COVID-19can be life-threatening. Objective: To determine some characteristics of COVID-19in the pediatric population studied with type 1 diabetes mellitus during the first year of the onset of the pandemic in Cuba. Method: The pediatric endocrinology services of the provinces: Ciego de Ávila, Villa Clara, Pinar del Río and Havana (Hospital Pediátricos Cerro and Centro Habana) were randomly selected. It was requested how many patients during the first year of the pandemic (March 2020-March 2021) debuted with DM1, how many in ketosis / ketoacidosis. These data were compared with 2019. It was investigated how many T1D children were admitted with Covid 19. Results: There was an increase (57.3%) in patients with T1D debut during the first year of the pandemic compared to 2019. The presence of ketosis / ketoacidosis increased (58.2 %). 4 patients with Covid 19 and DM1 were detected (low frequency: 0.53%). Conclusions: The increase in DM1 and ketosis/ketoacidosis could be indirectly related to the Covid 19 pandemic, whether due to stress, confinement, inadequate nutrition or a combination of these factors, it is prudent to have a medium and long-term follow-up of these patients.

DKA and new-onset type 1 diabetes in Brazilian children and adolescents during the COVID-19 pandemic

ABSTRACT We assess the severity and frequency of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) patients and in patients with previous diagnosis of T1D in a referral Brazilian university hospital in the first five months of the COVID-19 pandemic. We also compare the data with data from pre-pandemic periods. Forty-three new-onset T1D patients were diagnosed between April and August of the years 2017, 2018, 2019, and 2020. During the COVID-19 pandemic, the number of new-onset T1D was over twice the number of new-onset T1D in the same period in the three previous years. All the 43 patients survived and are now on outpatient follow-up. We also compared the characteristics of the T1D patients hospitalized between April and August of the years 2017, 2018, and 2019 (32 hospitalizations) to the characteristics of the T1D patients hospitalized between April and August/2020 (35 hospitalizations; 1 patient was hospitalized twice in this period). Fourteen of the 34 patients admitted during the pandemic presented with COVID-19-related symptoms (any respiratory symptom, fever, nausea, vomiting, and diarrhea), but only one had positive SARS-CoV-2 RT-PCR test. Samples from 32 out of these 34 patients were assayed for SARS-CoV-2 antibodies, and four patients were positive for total antibodies (IgM and IgG). In agreement with recent reports from European countries, we observed increased frequency of DKA and severe DKA in new-onset and previously diagnosed T1D children and adolescents in a large referral public hospital in Brazil in the first five months of the COVID-19 pandemic. The reasons for this outcome might have been fear of SARS-CoV-2 infection in emergency settings, the more limited availability of primary healthcare, and the lack of school personnel's attention toward children's general well-being.

Recurrent hypoglycemic coma and diabetic ketoacidosis caused by insulin antibody: a rare case of type 1 diabetes mellitus / Hipoglicemia hiperinsulinémica causada por anticuerpos antiinsulina: informe de un caso

ABSTRACT Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal: 300 mU/L and < 0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.

Los anticuerpos contra la insulina (AI) inducidos por la insulina exógena raramente causan hipoglucemia. No obstante, los autoanticuerpos contra la insulina (AIA) en el síndrome autoinmune de insulina (SAI) pueden causar hipoglucemia. Las manifestaciones típicas del SAI son la hipoglucemia en ayunas o posprandial, niveles elevados de insulina, la disminución del nivel de péptido C y AIA positivos. Presentamos un paciente hombre de 45 años con diabetes mellitus de tipo 1 (DMT1) tratado con análogos de insulina, que sufría comas hipoglucémicos recurrentes y cetoacidosis diabética (CAD). Sus síntomas fueron causados por la insulina exógena y fueron similares al SAI. La posible razón fue que la insulina exógena indujo AI. El título de AI era del 61,95% (Normal: 300 mU/L y < 0,02 nmol/L cuando se producía la hipoglucemia. Basados en sus síntomas clínicos y otros exámenes, se le diagnosticó hipoglucemia hiperinsulinémica causada por la AI. Sus síntomas mejoraron después de cambiar el régimen de insulina de lispro más insulina detemir a insulina humana recombinante (Gensulin R) y de empezar a tomar prednisona.

Assessment of clinical profiles, and treatment outcomesforchildren with diabetic ketoacidosis, in two hospitals selectedfromAddis Ababa, Ethiopia, 2020

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]

Assessment of clinical profiles, and treatment outcomes for children with diabetic ketoacidosis, in two hospitals selected from Addis Ababa, Ethiopia, 2020

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors

COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa

Coronavirus disease 2019 (COVID-19) is associated with an increased prevalence and mortality from diabetic ketoacidosis (DKA) globally. With limited access to specialised care, most patients with DKA in South Africa are managed at district hospital level. This study describes the profile of patients admitted to a district hospital in South Africa with DKA and COVID-19 and examines associated risk factors encountered. Methods: This was a case series of all patients presenting to a district hospital with DKA and COVID-19 infection between July 2020 and July 2021. Data extracted included patients' demographic profiles, biochemical results, comorbidities and clinical outcomes. Results: The median age of the 10 patients admitted during the study period was 39 years old (±12), six of whom were male. The hemoglobin A1c (HbA1c) values on admission ranged from 9.7 to 13.8. Five of the patients had pre-existing type 2 diabetes mellitus (DM). Four of the known DM patients were on metformin only, and one was on biphasic insulin. Three patients had other pre-existing comorbidities, two patients with hypertension and one with human immunodeficiency virus (HIV). Three patients demised, two of whom were hypoxic on admission. Conclusion: Diabetic ketoacidosis appears more commonly in COVID-19 infected patients with type 2 DM and at a young age. Suboptimal glycaemic control was associated with DKA, and hypoxia was a strong predictor for mortality. Treatment inertia was evident in the known DM group, who were on monotherapy despite persistent hyperglycaemia. Greater vigilance is required to detect ketosis in type 2 DM and intensify therapy to improve glycaemic control.

Aspects cliniques et thérapeutiques du diabète de l'enfant à Ngaoundéré (Cameroun) / Clinical presentation and management of childhood diabetes at Ngaoundere City (Cameroon)

Objectif. L'étude visait à évaluer les aspects cliniques et thérapeutiques des enfants diabétiques suivis à l'hôpital régional de Ngaoundéré. Méthodes. Il s'agissait d'une étude transversale rétrospective descriptive conduite du 15 avril au 10 juillet 2021 à l'unité Changing Diabetes In Children (CDIC) de l'Hôpital Régional de Ngaoundéré. Les données sociodémographiques (l'âge, le sexe, la scolarité, la religion), cliniques (indice de masse corporelle, signes cliniques, antécédents familiaux, circonstance de découverte, complications du diabète, durée de la maladie) et thérapeutiques de 26 enfants diabétiques âgés de 8 à 20 ans et régulièrement suivis dans cette unité ont été analysées. Résultats. La population d'étude était constituée de 14 filles (53,8%) et de 12 garçons (46,2%). Les symptômes les plus fréquents observés étaient la polyurie (34,6%), l'amaigrissement et la polydipsie (38,5%). Les complications les plus fréquentes étaient, l'acidocétose (19,2%) lié à l'hyperglycémie chronique et l'hypoglycémie (57,7%) lié au traitement par insulinothérapie. En guise de traitement, 96,1% de ces patients étaient sous un schéma thérapeutique associant au quotidien une injection d'insuline d'action rapide (Actrapid) à deux injections d'insuline d'action intermédiaire (Insulatard ou Mixtard). Le taux moyen d'hémoglobine glyquée (9,27 ± 3,38%) traduisait un mauvais contrôle glycémique dans cette population. La proportion des patients contrôlés, c'est-à-dire, ceux qui avaient un taux d'hémoglobine glyquée inférieure ou égale à 7%, était plus faible chez les garçons (25%) comparés aux filles (42,9%). Conclusion. Nos données interpellent les différents acteurs impliqués dans la prise en charge du diabète de l'enfant, sur la nécessité d'amélioré la qualité de cette prise en charge

Objective. The study aimed at assessing the clinical and therapeutic aspects of diabetic children under follow-up at the Ngaoundere Regional Hospital. Methods. This was a descriptive retrospective cross-sectional study conducted from April 15 to July 10, 2021, at the Changing Diabetes In Children (CDIC) unit of the Ngaoundéré Regional Hospital. Sociodemographic data (age, sex, education, religion), clinical data (body mass index, clinical signs, family history, circumstance of discovery, complications of diabetes, duration of the disease), and therapeutic data of 26 diabetic children aged 8 to 20 and regularly followed in this unit were analyzed. Results. Our study population consisted of 14 girls (53.8%) and 12 boys (46.2%). The most common symptoms observed were polyuria (34.6%), weight loss, and polydipsia (38.5%). The most common complications were ketoacidosis (19.2%) related to chronic hyperglycemia and hypoglycemia (57.7%) related to insulin therapy. By way of treatment, 96.1% of these patients were on a therapeutic regimen combining a daily injection of fast-acting insulin (Actrapid) and two injections of intermediate-acting insulin (Insulatard or Mixtard). The average level of glycated hemoglobin (9.27 ± 3.38%) reflected poor glycemic control in this population. The proportion of controlled patients, that is to say, those who had a glycated hemoglobin level less than or equal to 7%, was lower in boys (25%) compared to girls (42.9%). Conclusion. Our data challenge the various actors involved in the management of childhood diabetes, on the need to improve the quality of this care.

Cetoacidose diabética em crianças e adolescentes com diabetes mellitus tipo 1 e fatores de risco associados / Diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus and associated risk factors / Cetoacidosis diabética en niños y adolescentes con diabetes mellitus tipo 1 y factores de riesgo asociados

RESUMO Objetivo estimar a prevalência e fatores de risco de cetoacidose diabética em crianças e adolescentes com Diabetes Mellitus tipo 1. Método estudo epidemiológico de corte transversal em que foram analisados prontuários de crianças e adolescentes com Diabetes Mellitus tipo 1, internadas nos últimos 10 anos em um hospital público de referência do município de Campina Grande, Brasil, no período de 2009 a 2019. Os dados foram analisados por estatística descritiva, bivariada e multivariada por regressão de Poisson. Resultados foram analisados 130 prontuários e 46,2% apresentaram cetoacidose diabética. As variáveis independentes que impactaram, de forma significativa e conjunta, com o desfecho foram: idade, infecção, erro alimentar e erro na dosagem de insulina. Conclusão a cetoacidose diabética foi um achado comum em crianças e adolescentes com Diabetes Mellitus tipo 1. Os resultados contribuem com a assistência de enfermagem e permitem implementar intervenções de prevenção e manejo adequado do problema

ABSTRACT Objective to estimate the prevalence and risk factors of diabetic ketoacidosis in children and adolescents with Type 1 Diabetes Mellitus. Method an epidemiological, cross-sectional and cohort study that analyzed the medical charts of children and adolescents with Type 1 Diabetes Mellitus admitted over a 10-year period to a public reference hospital in the municipality of Campina Grande, Brazil, from 2009 to 2019. The data were analyzed by means of descriptive statistics, both bivariate and multivariate through Poisson regression. Results 130 medical charts were analyzed, of which 46.2% presented diabetic ketoacidosis. The independent variables that significantly and jointly impacted on the outcome were the following: age, infection, diet error and error in insulin dosage. Conclusion diabetic ketoacidosis was a common finding in children and adolescents with Type 1 Diabetes Mellitus. The results contribute to Nursing care and allow implementing intervention for the prevention and adequate management of the problem.

RESUMEN Objetivo: estimar la prevalencia y los factores de riesgo de la cetoacidosis diabética en niños y adolescentes con Diabetes Mellitus tipo 1. Método estudio epidemiológico de cohorte transversal en el que se analizaron historias clínicas de niños y adolescentes con Diabetes Mellitus tipo 1 internados en un período de 10 años en un hospital público de referencia del municipio de Campina Grande, Brasil, entre 2009 y 2019. Los datos se recolectaron por medio de estadística descriptiva, bivariada y multivariada por regresión de Poisson. Resultados se analizaron 130 historias clínicas, de las cuales el 46,2% presentó cetoacidosis diabética. Las variables independientes que afectaron en forma significativa y conjunta el desenlace fueron las siguientes: edad, infección, error en la dieta y error en la posología de insulina. Conclusión la cetoacidosis diabética fue un hallazgo común entre niños y adolescentes con Diabetes Mellitus tipo 1. Los resultados contribuyen a la atención de Enfermería y permiten implementar intervenciones para la prevención y el manejo adecuado del problema.

Principales causas de Cetoacidosis Diabética en pacientes mayores de 15 años que ingresaron en Hospital Militar Central en el período de enero a junio del 2022 / Main causes of Diabetic Ketoacidosis in patients older than 15 years who were admitted to the Central Military Hospital in the period from January to June 2022

La cetoacidosis diabética (CAD) es una de las principales complicaciones agudas de la Diabetes Mellitus (DM), además de ser una de las principales causas de morbimortalidad para pacientes que sufre de esta enfermedad. Es una complicación que se produce por una disminución en la insulina efectiva circulante, así como al aumento de hormonas contra-reguladoras, como glucagón, catecolaminas, cortisol y hormona de crecimiento (1). Por lo cual motiva a realizar la presente investigación con el fin de contribuir a los conocimientos de la población salvadoreña, para evitar las complicaciones agudas de la Diabetes Mellitus, y mejorar la calidad de vida de los pacientes que consultan, se tomara una población de 34 pacientes que ingresaron al Hospital Militar Central por Diabetes Mellitus, de los cuales 7 de ellos cumplían criterios clínicos y de laboratorio de Cetoacidosis Diabética en el periodo comprendido de enero a junio de 2022, se utilizó como técnica de investigación la consulta y revisión de expediente clinico virtual mediante un formulario de recolección de datos a partir del expediente clinico virtual del Sistema de Gestión Hospitalaria. Toda esta información recolectada se registró en una base de datos de Microsoft Excel para luego ser presentadas en tablas porcentuales y gráficos de barra. El Instrumento de recolección de datos incluye las características de la población estudiada las cuales eran pacientes cuyas edades iban desde los 18 hasta los 83 años de edad, de sexo masculino en su mayoría tratados con insulina y sulfonilureas, con estancia hospitalaria menor a los 7 días, los cuales como principal causa de Cetoacidosis diabética fue la inadecuada adherencia al tratamiento, además de presentar un cuadro resolutivo cuya duración fue menor a las 24 horas de estancia hospitalaria., así mismo se presentará formalmente al decanato de Medicina de la Universidad Salvadoreña "Alberto Masferrer" con el fin de que el presente documento contribuya a aportar conocimientos sobre la problemática en estudio.

Diabetic ketoacidosis (DKA) is one of the main acute complications of Diabetes Mellitus (DM), as well as being one of the main causes of morbidity and mortality for patients suffering from this disease. It is a complication that is produced by a decrease in effective circulating insulin, as well as an increase in counterregulatory hormones, such as glucagon, catecholamines, cortisol, and growth hormone (1). Therefore, it motivates to carry out the present investigation in order to contribute to the knowledge of the Salvadoran population, to avoid the acute complications of Diabetes Mellitus, and improve the quality of life of the patients who consult, a population of 34 will be taken. patients who were admitted to the Central Military Hospital due to Diabetes Mellitus, of which 7 of them met clinical and laboratory criteria for Diabetic Ketoacidosis in the period from January to June 2022, the consultation and review of clinical records was used as a research technique virtual through a data collection form from the virtual clinical record of the Hospital Management System. All this collected information was recorded in a Microsoft Excel database to later be presented in percentage tables and bar graphs. The data collection instrument includes the characteristics of the studied population, which were patients whose ages ranged from 18 to 83 years of age, mostly male, treated with insulin and sulfonylureas, with a hospital stay of less than 7 days. , which as the main cause of diabetic ketoacidosis was inadequate adherence to treatment, in addition to presenting a resolving picture whose duration was less than 24 hours of hospital stay, likewise it will be formally presented to the Dean of Medicine of the Salvadoran University "Alberto Masferrer" in order that this document contributes to provide knowledge about the problem under study.

The first series of cases of ketosis-prone type 2 diabetes (flatbush diabetes) in Brazilian adults

SUMMARY Ketosis-prone type 2 diabetes (KPD) is an emerging form of diabetes mellitus characterized by unprovoked ketoacidosis, absence of autoimmunity and beta-cell dysfunction. The KPD may improve after initial glycemic compensation and evolve to exogenous insulin independence, most cases were observed in populations with African or Hispanic backgrounds. We reviewed the literature on KPD and, to date, only one case of KPD has been described in Brazil's multi-ethnic population. A group of adult Brazilian KPD patients without autoimmunity and insulinopenia was identified for this study. We report a retrospective study of four KPD cases (3 males) evaluated in southeast Brazil, the patients were overweight or obese, age between the third and fifth decades of life, had a family history of type 2 diabetes, hyperglycemia (809.5 ± 344.2 mg/dL), acidosis (pH 7.21 ± 0.07; normal range (nr): 7.35-7.45 and bicarbonate 9.1 ± 6.2; nr: 22-26 mEq/mL), ketonuria (142.5 ± 114.4 mg/dL; nr: absence), absence of glutamic acid decarboxylase antibodies (GAD-65), and beta-cell function reserve (C-peptide 1.19 ± 0.53 ng/mL - nr: 1.1-4.4 ng/mL) on diagnosis. After glycemic compensation, there was increase of C-peptide (2.21 ± 0.41) indicating the recovery of beta-cell function and the time to insulin independence was 7.7 ± 3.5 months. They evolved after the period of glucotoxicity with insulin withdrawal and could be treated with oral antidiabetic therapy. This is the first case series of KPD described in Brazil being characterized by ketoacidosis at diagnosis, absence of autoimmunity, recovery of beta-cell function and insulin independence.

Marcadores inmunológicos de diabetes tipo 1: análisis de 4.164 perfiles en un centro de salud de Chile / Analysis of 4, 164 type 1 diabetes antibody profiles in a Chilean health centre

Background: Previous studies have assessed the role of Type 1 diabetes (DM1) antibodies as predictors of the natural history of disease. Aim: To determine the frequency and combinations of positivity for DM1 antibodies in patients with DM1 and the relationship between antibody positivity and the age of the patient. To explore the relationship between history of insulin therapy or diabetic ketoacidosis (DKA) at the onset of the disease with antibody positivity in a subsample. Material and Methods: Data was gathered from every sample processed for DM1 antibodies in our laboratory between January 2015 and September 2019. Medical records from 84 patients who tested positive for at least one antibody were revised to study the relationship between insulin therapy or DKA at the onset of the disease with antibody positivity. Results: Forty percent of DM1 antibody tests were positive. Among positive tests, 1, 2, 3 or 4 DM1 antibodies were detected in 48%, 33%, 17% and 3% of cases, respectively. The likelihood of testing positive was inversely related with age for ICA, GAD, IA-2, ZnT8 and directlyproportionalforIAA (p= −0,012; −0,013; −0,014; −0,009; 0,005 respectively). An association between DKA at the onset of the disease and IA-2 positivity was observed (Odds ratio (OR) 5.38 95% confidence intervals (CI) 1.79 − 16.16, P < 0.01). No association was found between IAA positivity and history of insulin therapy (OR 2.25 95%CI 0.63 − 7.90, P = 0.2403). The results obtained from this study represent a novel local profile of DM1 antibody data, highlighting a relationship between antibody positivity and age.