Vitamin D Level of Children with Diabetic Ketoacidosis in Pediatric Intensive Care Unit

Year 2023, Volume: 33 Issue: 5, 523 - 526, 25.10.2023

Mutlu Uysal Yazici , Erhan Ozel , Emine Gulsah Torun , Şenay Savaş Erdeve , Semra Çetinkaya

https://doi.org/10.54005/geneltip.1301387

Abstract

Aims: Vitamin D deficiency is a risk factor for autoimmune diseases such as diabetes mellitus. This study aimed to investigate the association between Diabetic ketoacidosis (DKA) and vitamin D levels and the impact of vitamin D on the duration of DKA and pediatric intensive care unit length of stay in Turkish pediatric patients.
Methods: The study was a retrospective study conducted between January 2014 and March 2018. The study population was children under 18 admitted to the pediatric intensive care unit (PICU) with DKA.
Results: The study included 130 patients, 51.5% of them were females. We found vitamin D deficiency in 39.2%(n=51) and vitamin D insufficiency in 33.1% (n=43) of the patients. Most of the patients with severe acidosis had low vitamin D levels (44/59) and % 45.8 of them (27/59) had vitamin D deficiency. Duration of diabetic ketoacidosis, length of pediatric intensive care unit stay, and hospitalization stay were longer in patients with low vitamin D levels but were not statistically significant.
Conclusions: This study is the first study evaluating the association between vitamin D and diabetic ketoacidosis in Turkey. Although there is no association between vitamin D deficiency and the duration of diabetic ketoacidosis and the severity of acidosis, vitamin D deficiency is substantially common in patients with diabetic ketoacidosis.

Keywords

Diabetic ketoacidosis, Diabetes mellitus, Pediatrics, Vitamin D

Pediatrik Yoğun Bakım Ünitesindeki Diyabetik Ketoasidozlu Çocukların D Vitamini Düzeylerinin Değerlendirilmesi

Abstract

Amaç: Vitamin D eksikliği, diabetes mellitus gibi otoimmün hastalıkların gelişimi için bir risk faktörüdür. Bu çalışma, çocuk hastalarda Diyabetik ketoasidoz (DKA) ile serum D vitamini düzeyleri arasındaki ilişkiyi ve D vitamininin DKA süresi ve çocuk yoğun bakım ünitesinde kalış süresine etkisini araştırmayı amaçlamıştır.
Metot: Çalışma, Ocak 2014-Mart 2018 tarihleri arasında yürütülen retrospektif bir çalışmadır. Çalışma popülasyonu DKA tanısı ile çocuk yoğun bakım ünitemizde (ÇYBÜ) takip edilen 18 yaş altı çocuklar oluşturmaktadır.
Bulgular: Çalışmaya 130 hasta dahil edildi ve bunların %51.5'i kadındı. Hastaların %39.2'sinde (n=51) D vitamini eksikliği, %33.1'inde (n=43) D vitamini yetersizliği olduğunu bulundu. Şiddetli asidozlu hastaların çoğunda D vitamini düzeyi düşük (44/59) ve % 45.8'inde (27/59) D vitamini eksikliği vardı. D vitamini düzeyi düşük olan hastalarda diyabetik ketoasidoz süresi, pediatrik yoğun bakımda kalış süresi ve hastanede kalış süresi daha uzundu ancak istatistiksel olarak anlamlı değildi.
Sonuç: Bu çalışma, Türkiye'de D vitamini ile diyabetik ketoasidoz ilişkisini değerlendiren ilk çalışmadır. D vitamini eksikliği ile diyabetik ketoasidoz süresi ve asidozun şiddeti arasında bir ilişki olmamasına rağmen, diyabetik ketoasidozlu hastalarda D vitamini eksikliği oldukça yaygındır.

Keywords

Diyabetik ketoasidoz, Diabetes mellitus, Pediatri, Vitamin D düzeyi

References

• American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34 Suppl 1(Suppl 1):S62-S69.
• Mobasseri M, Shirmohammadi M, Amiri T et al. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020;10(2):98-115.
• Wolfsdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care, 2006, 29(5), 1150–1159.
• Yang CY, Leung PS, Adamopoulos IE, et al. The implication of vitamin D and autoimmunity: a comprehensive review. Clin Rev Allergy Immunol. 2013 ;45(2):217-26.
• Pozzilli P, Manfrini S, Crinò A et al. Low levels of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 in patients with newly diagnosed type 1 diabetes. Horm Metab Res. 2005;37(11):680-3.
• Littorin B, Blom P, Schölin A et al. Lower levels of plasma 25-hydroxyvitamin D among young adults at diagnosis of autoimmune type 1 diabetes compared with control subjects: results from the nationwide Diabetes Incidence Study in Sweden (DISS). Diabetologia. 2006;49(12):2847-52.
• Hyppönen E, Läärä E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet (London, England). 2001;358(9292):1500-1503.
• Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group. Diabetologia. 1999;42(1):51-4.
• Al-Zubeidi H, Leon-Chi L, Newfield RS. Low vitamin D level in pediatric patients with new-onset type 1 diabetes is common, especially if in ketoacidosis. Pediatr Diabetes. 2016;17(8):592-598.
• Huynh T, Greer RM, Nyunt O et al. The association between ketoacidosis and 25(OH)-vitamin D levels at presentation in children with type 1 diabetes mellitus. Pediatr Diabetes. 2009;10(1):38-43.
• Devidayal, Singh MK, Sachdeva N, Singhi S et al. Vitamin D levels during and after resolution of ketoacidosis in children with new-onset Type 1 diabetes. Diabet Med. 2013;30(7):829-34.
• “Refining the Diagnostic Criteria for Diabetic Ketoacidosis | American Diabetes Association.” https://professional.diabetes.org/abstract/refining-diagnostic-criteria-diabetic-ketoacidosis (accessed. 10, 2021).
• Wolfsdorf JI, Glaser N, Agus M, Fritsch M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric diabetes, 19, 2018, 155-177.
• Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016 ;101(2):394-415.
• Tai K, Need AG, Horowitz M, Chapman IM. Vitamin D, glucose, insulin, and insulin sensitivity. Nutrition, 2008, 24(3), 279–285.
• Iqbal A, Hussain A, Iqbal A, Kumar V. Correlation Between Vitamin D Deficiency and Diabetic Ketoacidosis. Cureus. 2019;11(4):e4497.
• Alpdemir M, Alpdemir MF. Meta-Analysis Vitamin D deficiency status in Turkey: A meta-analysis. Int J Med Biochem, 2019, 2(3), 118-31.
• Andiran N, Çelik N, Akça H, Doǧan G. Vitamin D deficiency in children and adolescents. JCRPE J. Clin. Res. Pediatr. Endocrinol., 2012, 4(1), 25–29.
• Demiral M, Sırmagül B, Kirel B. Endokrin Polikliniğine Başvuran Çocuklarda D Vitamini Düzeyleri. Güncel Pediatri. 2016; 14(2): 60-66.
• Saggese G, Vierucci F, Boot AM et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr. 2015;174(5):565-76.
• Svoren BM, Volkening LK, Wood JR, Laffel LMB. Significant Vitamin D Deficiency in Youth with Type 1 Diabetes Mellitus. J. Pediatr., 2009, 154(1), 132–134.
• Janner M, Ballinari P, Mullis E, Flück CE. High prevalence of vitamin D deficiency in children and adolescents with type 1 diabetes. Swiss Med Wkly, 2010, 140, p. 13091.
• Bener A, Alsaied A, Al-Ali M et al. High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol. 2009 ;46(3):183-9.
• Tunc O, Cetinkaya S, Kízílgün M, Aycan Z. Vitamin D status and insulin requirements in children and adolescents with type 1 diabetes. J. Pediatr. Endocrinol. Metab., 2011, 24(11–12), 1037–1041.
• Dogan B, Oner C, Feyizoglu G, et al. Vitamin D status of Turkish type 1 diabetic patient. Diabetes Metab. Syndr. Clin. Res. Rev., 2019, 13(3), 2037–2039.
• Lee SW, Russell J, Avioli LV. 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol: conversion impaired by systemic metabolic acidosis. Science. 1977;195(4282):994-6.
• Cunningham J, Bikle DD, Avioli LV. Acute, but not chronic, metabolic acidosis disturbs 25-hydroxyvitamin D3 metabolism. Kidney Int. 1984;25(1):47-52.
• Blanton D, Han Z, Bierschenk L et al. Reduced serum vitamin D-binding protein levels are associated with type 1 diabetes. Diabetes. 2011;60(10):2566-70.
• McNally JD, Menon K, Chakraborty P, et al. The association of vitamin D status with pediatric critical illness. Pediatrics. 2012;130(3):429-36.
• Zhang YP, Wan YD, Sun TW, et al. Association between vitamin D deficiency and mortality in critically ill adult patients: A meta-analysis of cohort studies. Crit. Care, 2014, 18(6), 684.
• Das S, Kiran Kumar M, Biswal N, et al. Association Between Vitamin D Deficiency and Duration of Hospital Stay, Pediatric Intensive Care Unit Stay, and Ventilation; Pediatric Risk of Mortality Score; and Rate of Readmission: A Prospective Observational Study. Cureus. 2020, 12(9), e10322.