Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics.

BACKGROUND: Diabetic ketoacidosis (DKA) has significant morbidity and mortality, and is common at diagnosis in children. OBJECTIVE: Describe the frequency and severity of DKA at diagnosis of type 1 diabetes mellitus (T1DM) in children in Kuwait. METHODS: Hospital records of 677 diabetic children less than 12 yr of age, diagnosed during the period of 2000-2006 were reviewed. DKA was defined as blood glucose > 11 mmol/L, pH < 7.3, and/or bicarbonate < 15 mmol/L with ketonuria. RESULTS: Of all patients diagnosed with T1DM, 255 (37.7%) presented with DKA. The frequency of DKA was constant between 2000 and 2002 (42.7-41.5%), but decreased in the following years to 30.7% in 2006 (p < 0.005). The majority had either mild or moderate DKA (74.1%). Fifty-one (36.7%) of all children in the 0-4 yr had severe DKA compared to ten (2.9%) in the 5- to 8-yr-old group, and three (1.5%) in 9- to 12-yr-old patients (p < 0.0001). Moreover, 83% of children with severe DKA were in the 0-4 yr age group. One child (0.15%) died and twenty-seven (4%) needed intensive care unit (ICU) care. CONCLUSION: Our study provides recent data on Middle Eastern population, for whom data are sparse. Although it has significantly decreased, the frequency of DKA at presentation of T1DM in children in Kuwait is still high, secondary to the high prevalence of diabetes in the community. Young children, especially those less than 2 yr old remain at high risk. Increasing the general awareness of the public as well as of pediatricians to the disease may lead to early diagnosis before the development of acidosis.

Incidence and seasonal variation of Type 1 diabetes in children in Farwania area, Kuwait (1995-1999).

The aim of our study was to confirm the continuing rise in the incidence of Type 1 diabetes among Kuwaiti children aged 0-14, and to assess the effect of seasonality on incidence. Data from all newly diagnosed diabetic children between the period of 1995 and 1999 were analyzed. A total of 129 cases of Type 1 diabetes were diagnosed during the study period, of whom 68 were Kuwaiti nationals and were included in the study. The incidence was 20.18 per 100,000 (95% CI 16.3-28.2). Incidence rates for the age-groups 0-4, 5-9 and 10-14 were 8.12, 21.07 and 34.06, respectively. There was a significant female predominance (F:M ratio was 1.4:1, P<0.05). More cases were diagnosed in the cool months (November-February) compared with the warm months (June-September, P<0.05). There was increase in incidence from 1995 to 1999, but compared with data from the 1980s on the same age group, incidence has increased. A positive family history of Type 1 diabetes in a close relative was recorded for 30% of the patients. Although, only data from one hospital were included, Kuwait is very small geographically and not likely to have differences between different areas. Stress factors, economic growth, changes in the nutritional habits and the adoption of the western lifestyle may explain some of this increase.