Diabetische Ketoazidoseraten bei Manifestation eines Typ-1-Diabetes bei Kindern und Jugendlichen in Sachsen

ZUSAMMENFASSUNG

Der Typ-1-Diabetes tritt meist schon im Kindes- und Jugendalter auf. Durch die irreversible Störung der Insulinproduktion bei einem neu manifestierten Diabetes Typ 1 kann die für den Körper benötigte Energie nicht mehr aus Glukose gewonnen werden, sondern ersatzweise aus Fett. Infolge des Fettabbaues kann es dann zu einer diabetische Ketoazidose kommen.

Durch Auswertung des Sächsischen Kinder-Diabetes-Registers konnte eine überproportionale Zunahme an diabetischen Ketoazidosen bei Manifestation gegenüber der ebenfalls, aber nur moderat steigenden Typ-1-Diabetes-Inzidenz verzeichnet werden.

Somit ist ein Präventionsprogramm zur Senkung der Ketoazidoseraten bei Manifestation durch Früherkennung eines Typ-1-Diabetes dringend erforderlich.

ABSTRACT

Type 1 diabetes usually occurs in childhood and adolescence. The associated irreversible disruption of insulin production has the effect that the energy needed by the body cannot be obtained from glucose, but instead from fat as a substitute. The fat breakdown can lead to diabetic ketoacidosis.

Evaluations of the Saxon Child Diabetes Registry showed a disproportionate increase in diabetic ketoacidosis compared to the increasing incidence of type 1 diabetes.

Thus, a prevention program for early detection of type 1 diabetes is urgently needed, which is supposed to be accompanied by a reduction of ketoacidosis rates at manifestation of type 1.

Schlüsselwörter

Typ-1-Diabetes - pädiatrisch - Register - Epidemiologie - Ketoazidose

Keywords

Type 1 diabetes - pediatric - registry - epidemiology - ketoacidosis

Publication History

Article published online:
19 April 2023

• Literatur

• 1 Mortensen HB, Swift PG, Holl RW. et al Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis. Pediatric diabetes 2010; 11: 218-226
• 2 Bodin J, Stene LC, Nygaard UC. Can exposure to environmental chemicals increase the risk of diabetes type 1 development?. Biomed Res Int 2015; 2015: 208947
• 3 Cohen A, Richards T, Allen B. et al Health issures in the industrial part zone of Marseille, France: the Fos EPSEAL community-based cross-sectional survey. Journal of Public Health 2018; 26: 235-243
• 4 Hathout EH, Beeson WL, Ischander M. et al Air pollution and type 1 diabetes in children. Pediatric diabetes 2006; 07: 81-87
• 5 Mohr SB, Garland CF, Gorham ED. et al The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Diabetologia 2008; 51: 1391-1398
• 6 Hermann R, Knip M, Veijola R. et al Temporal changes in the frequencies of HLA genotypes in patients with Type 1 diabetes – indication of an increased environmental pressure?. Diabetologia 2003; 46: 420-425
• 7 Kukko M, Virtanen SM, Toivonen A. et al Geographical variation in risk HLA-DQB1 genotypes for type 1 diabetes and signs of beta-cell autoimmunity in a high-incidence country. Diabetes care 2004; 27: 676-681
• 8 Gulden E, Wong FS, Wen L. The gut microbiota and Type 1 Diabetes. Clin Immunol 2015; 159: 143-153
• 9 Cardwell CR, Carson DJ, Patterson CC. Parental age at delivery, birth order, birth weight and gestational age are associated with the risk of childhood Type 1 diabetes: a UK regional retrospective cohort study. Diabet Med 2005; 22: 200-206
• 10 Cardwell CR, Stene LC, Ludvigsson J. et al Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies. Diabetes care 2012; 35: 2215-2225
• 11 Bendas A, Rothe U, Kiess W. et al Trends in Incidence Rates during 1999–2008 and Prevalence in 2008 of Childhood Type 1 Diabetes Mellitus in GERMANY – Model-Based National Estimates. PloS one 2015; 10: e0132716
• 12 Manuwald U, Heinke P, Salzsieder E. et al Incidence trends of type 1 diabetes before and after the reunification in children up to 14 years of age in Saxony, Eastern Germany. PloS one 2017; 12: e0183665
• 13 Patterson CC, Dahlquist GG, Gyurus E. et al Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet (London, England) 2009; 373: 2027-2033
• 14 Große J, Hornstein H, Manuwald U. et al Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index (HDI): An Updated Systematic Review, Meta-Analysis, and Meta-Regression. Horm Metab Res 2018; 50: 209-222
• 15 Ucar A, Saka N, Bas F. et al Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted. Journal of pediatric endocrinology & metabolism : JPEM 2013; 26: 1059-1065
• 16 Hekkala A, Ilonen J, Knip M. et al Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis. European journal of endocrinology/European Federation of Endocrine Societies 2011; 165: 813-817
• 17 Samuelsson U, Stenhammar L. Clinical characteristics at onset of Type 1 diabetes in children diagnosed between 1977 and 2001 in the south-east region of Sweden. Diabetes research and clinical practice 2005; 68: 49-55
• 18 Hekkala A, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 diabetes in children in northern Finland: temporal changes over 20 years. Diabetes care 2007; 30: 861-866
• 19 Jefferies C, Cutfield SW, Derraik JG. et al 15-year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting (Auckland, New Zealand). Scientific reports 2015; 05: 10358
• 20 Rewers A, Dong F, Slover RH. et al Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998–2012. Jama 2015; 313: 1570-1572
• 21 Manuwald U, Schoffer O, Hegewald J. et al Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study. PloS one 2019; 14: e0218807
• 22 Galler A, Stange T, Muller G. et al Incidence of childhood diabetes in children aged less than 15 years and its clinical and metabolic characteristics at the time of diagnosis: data from the Childhood Diabetes Registry of Saxony, Germany. Hormone research in paediatrics 2010; 74: 285-291
• 23 Manuwald U, Schoffer O, Kugler J. et al Trends in incidence and prevalence of type 1 diabetes between 1999 and 2019 based on the Childhood Diabetes Registry of Saxony, Germany. PloS one 2021; 16: e0262171
• 24 Green A, Gale EA, Patterson CC. Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE Study. Lancet (London, England) 1992; 339: 905-909
• 25 Wolfsdorf JI, Allgrove J, Craig ME. et al ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric diabetes 2014; 15 (Suppl. 20) 154-179
• 26 Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet (London, England) 2014; 383: 69-82
• 27 Hommel A, Haupt F, Delivani P. et al Screening for Type 1 Diabetes Risk in Newborns: The Freder1k Pilot Study in Saxony. Horm Metab Res 2018; 50: 44-49