Articles, Issue 1/2024

Prevalence of islet autoantibodies and diabetic ketoacidosis among children and adolescents with newly diagnosed diabetes mellitus at one Diabetes Center (2019 – 2023)

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Yuliya Bazdarska, Hari Stefanov, Yana Bocheva, Gergana Chausheva, Violeta Iotova


Abstract

Background: Worldwide, the most frequentinitial presentation of type 1 diabetes (T1D) is still the diabetic ketoacidosis. Being an autoimmune diseases, T1D most frequently associates with islet autoantibodies (Abs).

Aim: To evaluate the frequency of positive diabetes-associated islet autoantibodies and the prevalence of DKA at T1D diabetes onset in youth at Varna’s diabetes center for a period of four years (2019 – 2023).

Methods: All 160 consecutive newly-diagnosed patients were enrolled in the study. Demographic and laboratory data was collected. Participants were tested for anti-GAD65, anti-IA2 and anti-IAA by ELISA.

Results: The mean age of the participants was 9.0±4.3 years (57% boys). Of total, 44.3% were with initial DKA, and 16.9% were with severe DKA. Weak significant correlations were found between the level of DKA and age (r=-0.143, p<0.03), HbA1c (r=0.26, p=0.001) as well as C-peptide levels (r=-0.204, p=0.012). Of total, 81.6% were with at least one positive diabetes related autoantibody – 34% had 1 positive Ab,  41.5% had 2 Abs  and 6.1% of patients were with 3 positive Abs. The most frequent Ab was anti-GAD65 (69.4%) followed by anti-IA2 (51%), and anti-IAA (15.6%), p<0.01. Weak significant correlations were found between positivity of anti-GAD65 and anti-IAA (r=0.310, <0.0001). N correlation was found between the presence and number of positive autoantibodies and the DKA severity.

Conclusion: Initial DKA continues to be very frequent at T1D presentation in youth especially at younger age, higher BGL and lower C-peptide. The high prevalence of positive diabetic autoantibodies at diagnosis is a compelling proof for their routine testing in preclinical stages of T1D and screening in siblings to prevent diabetic ketoacidosis.

Keywords: diabetic ketoacidosis, initial DKA, type 1 diabetes mellitus, antibodies, anti-GAD, anti-IA2, anti-IAA

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Address for correspondence:

First Pediatric clinic with PICU;
University Hospital “Sveta Marina”, Varna
1, “Hr. Smirnenski”, Blvd. floor 5
9010, Varna
Bulgaria
Email: yuliya.bazdarska@gmail.com