Is HbA1c an Indicator of Diabetic Ketoacidosis Severity in the Pediatric Population?
Riwaaj Lamsal1, Leslie Klyachman, Adebayo Adeyinka
1From the Department of Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY.
Insights
Higher glycosylated hemoglobin (HbA1c) levels are linked to more severe diabetic ketoacidosis (DKA) in pediatric patients. This study found a significant correlation between elevated HbA1c and DKA severity.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- Glycosylated hemoglobin (HbA1c) indicates long-term glycemic control and predicts diabetes complications.
- Diabetic ketoacidosis (DKA) severity is assessed by acidosis, guiding patient care and prognosis.
- Previous research suggests higher HbA1c may precede recurrent DKA, but its association with DKA severity was unclear.
Purpose of the Study:
- To investigate the association between glycosylated hemoglobin (HbA1c) levels and the severity of diabetic ketoacidosis (DKA) in pediatric patients.
- To determine if higher HbA1c levels correlate with more severe DKA episodes.
Main Methods:
- Retrospective analysis of 88 pediatric patients (aged 1-21 years) admitted to the PICU with DKA between 2011 and 2015.
- Spearman correlation was used to analyze the relationship between HbA1c levels and DKA severity (based on blood pH).
- Data included HbA1c, blood glucose, serum creatinine, and blood pH levels.
Main Results:
- The mean HbA1c for patients with mild, moderate, and severe DKA was 11.4%, 12.2%, and 14.8%, respectively.
- A significant negative correlation was found between blood pH and HbA1c (r = -0.557, P = 0.005).
- HbA1c showed a positive correlation with DKA severity groups (r = 0.595, P = 0.01), indicating higher HbA1c is linked to more severe DKA.
Conclusions:
- Elevated HbA1c levels are associated with increased severity of diabetic ketoacidosis in pediatric patients.
- HbA1c may serve as a valuable indicator for predicting DKA severity in young individuals with diabetes.
- Further research can explore HbA1c's role in DKA management and prevention strategies.
Abstract:
Glycosylated hemoglobin (HbA1c) reflects how well blood glucose is controlled and is one of the strongest predictors of chronic complications of diabetes mellitus. The degree of acidosis helps determine the severity of diabetic ketoacidosis (DKA) (mild: pH 7.2-7.3; moderate: pH 7.1-7.2; severe: pH <7.1) and guides the level of care and predicts outcome. Many studies have implicated that higher HbA1c levels lead to recurrent DKA. However, there is no description of the association of higher HbA1c with the severity of DKA. One hundred thirty-eight electronic medical records of patients aged 1 to 21 years admitted to the pediatric intensive care unit with DKA between 2011 and 2015 were analyzed. We excluded 50 patients because the HbA1c level was not available. Spearman correlation analyzed the data for 88 patients included in the study. The mean HbA1c was 13.3, with female patients having more admissions compared with male patients (58% vs 42%). The age group from 13 to 21 years accounted for 77.3% of the patients. The duration of type 1 diabetes mellitus did not affect the HbA1c level. Likewise, the blood glucose and serum creatinine level did not show a statistical correlation with blood pH levels. Mean HbA1c for mild, moderate, and severe DKA groups were 11.4%, 12.2%, and 14.8%, respectively. Blood pH and HbA1c returned a negative correlation (correlation coefficient, -0.557; P = 0.005). The HbA1c level correlated positively with the 3 groups of DKA (correlation coefficient, 0.595; P = 0.01). A higher A 1c was associated with more severe DKA.
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