Early detection of autoimmune type 1 diabetes could reduce the risk of diabetic ketoacidosis

Anti-islet autoantibodies, responsible for destruction of insulin-producing beta-cells, can be detected during the presymptomatic phase (Stage 1 and 2) of autoimmune T1D. If left undetected, there is progression from the presymptomatic phase to symptomatic phase (Stage 3), which is characterized by beta-cell functional loss and hyperglycemia, which may often lead to ketoacidosis.⁶

Screening for beta-cell autoantibodies in high-risk individuals allows for early diagnosis of T1D, timely intervention through monitoring and treatment, and prevention of complications such as DKA.^1,6 Moreover, preventing DKA through screening results in reduced DKA-associated morbidity, mortality, and healthcare cost.⁴

Diabetic ketoacidosis predominantly affects people with T1D but can also occur in those with type 2 diabetes. Common triggers in both populations include catabolic stress from:⁹

• Acute illnesses and injuries
• Surgery
• Infections
• Non-compliance with treatment
• New-onset diabetes
• Other acute medical conditions

The risk of DKA is notably higher among younger children with T1D.¹ It is concerning that T1D diagnosis in children under 5 years often coincides with DKA. The reported prevalence of DKA in this age group at diagnosis ranges from 17.3% to 54.5%.⁴ Recognizing signs and symptoms in these children can be particularly challenging, potentially leading to delayed diagnosis.¹

Diabetic ketoacidosis can be evaluated through both clinical signs and laboratory tests. Clinically, DKA manifests with symptoms such as polyuria, polydipsia, hyperglycemia, weight loss and acetone breath.¹¹

In addition to clinical signs, DKA is characterized by specific laboratory findings, with the presence of:⁵

• Hyperglycemia (blood glucose >200 mg/dL),
• Metabolic acidosis (venous pH <7.3 or serum bicarbonate concentration
  <15 mEq/L), and
• Ketonemia or moderate/high ketonuria

The severity of DKA is primarily determined by the degree of acidosis observed in these laboratory parameters, as depicted in below table.⁵