Frequency and clinical characteristics of ketoacidosis at onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia.

To determine the frequency, and to describe the clinical characteristics of ketoacidosis at initial diagnosis of childhood type 1 diabetes mellitus (T1DM) in Al-Madina region of the Northwest province of Saudi Arabia. We retrospectively analyzed the hospital records of 311 (152 males and 159 females) children diagnosed with childhood T1DM in Al-Madina region, Saudi Arabia between January 1992 and December 2004. At diagnosis 172 (55.3%) children presented with diabetic ketoacidosis at the onset of their illness, 101 (58.7%) were females and 71 (41.3%) males. We found females to have more ketoacidosis at the onset of their illness with 1.4:1 female to male ratio. The mean age at presentation with ketoacidosis was 6.7 years (95% CI=5.6-7.8) ranging from 4 months to 14 years. Most of the ketoacidosis was mild to moderate (84.9%), while only 26 (15.1%) children had the severe type. Sixty-one (35.5%) children were in the younger age group, 54 (31.4%) were in the middle age group, and 57 (33.1%) were in older age group, there was no significant difference (p=0.5) between the 3 age groups in the frequency of ketoacidosis. The duration of symptoms before presentation with ketoacidosis was 15.8 days (95% CI=13.5-18.1). Altered consciousness was present in 21 (12.2%) children; all of them were from the severe type of ketoacidosis. There was a strong correlation between the severity of the central nervous system depression and the degree of acidosis (r=0.826, p<0.0001), but no correlation with age, gender, duration of symptoms, and blood glucose level. The frequency of ketoacidosis at onset of childhood diabetes mellitus in our region is significant. Prevention of diabetic ketoacidosis and reduction of its frequency should be a goal in managing children with diabetes. Rising standards of medical information and general awareness can contribute to this.