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

Yıl 2023, , 523 - 526, 25.10.2023
https://doi.org/10.54005/geneltip.1301387

Öz

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.

Kaynakça

  • 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.

Pediatrik Yoğun Bakım Ünitesindeki Diyabetik Ketoasidozlu Çocukların D Vitamini Düzeylerinin Değerlendirilmesi

Yıl 2023, , 523 - 526, 25.10.2023
https://doi.org/10.54005/geneltip.1301387

Öz

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.

Kaynakça

  • 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.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Mutlu Uysal Yazici 0000-0001-7377-4718

Erhan Ozel 0000-0001-8138-3514

Emine Gulsah Torun 0000-0003-2005-7082

Şenay Savaş Erdeve 0000-0002-4164-5089

Semra Çetinkaya 0000-0003-3974-2872

Erken Görünüm Tarihi 23 Ekim 2023
Yayımlanma Tarihi 25 Ekim 2023
Gönderilme Tarihi 24 Mayıs 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

Vancouver Uysal Yazici M, Ozel E, Torun EG, Savaş Erdeve Ş, Çetinkaya S. Vitamin D Level of Children with Diabetic Ketoacidosis in Pediatric Intensive Care Unit. Genel Tıp Derg. 2023;33(5):523-6.