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A new study has found that children with type 1 diabetes (T1D) who are hospitalised for Diabetic Ketoacidosis (DKA) are more likely to develop acute kidney injury (AKI), a sudden episode of renal failure or damage. DKA is a severe complication that occurs with prolonged hyperglycaemia. It may occur at the initial presentation of newly diagnosed T1D or in someone with pre-existing T1D in times of illness or insulin omission.

This is concerning because AKI is associated with increased morbidity and mortality as well as increased risk of chronic renal disease. This is especially relevant among children who are already at risk for diabetic nephropathy.

This study, published in JAMA Paediatrics investigated the medical records of 165 children hospitalised for DKA at British Columbia Children’s Hospital in Canada. Of the 165 children hospitalised for DKA, 106 (64.2%) developed AKI (AKI stage 1, 37 [34.9%]; AKI stage 2, 48 [45.3%]; and AKI stage 3, 21 [19.8%]). Two children required haemodialysis. This study is the first to date to document that a high proportion of children hospitalised for DKA develop AKI.

In Australia almost 6000 people, half under age 25, were hospitalised due to T1D related DKA in 2014-2015. DKA that occurs in people with undiagnosed T1D could be prevented through the earlier detection of type 1 diabetes at its onset.

This study highlights the already urgent need for strategies that improve early diagnosis of T1D. A recent study from US/Europe highlighted the benefits of early diagnosis of T1D. They found no DKA, increased endogenous production of insulin and reduced insulin needs for the first year post diagnosis in those diagnosed early.

In Australia, the Environmental Determinants of Islet Autoimmunity (ENDIA) study is investigating factors in the environment that may be causative or preventative of T1D. The ENDIA study regularly monitors participants from pregnancy through to 3 years of age. To find out more about ENDIA or get involved, head to their website. ENDIA is currently recruiting across all mainland states and regional areas.

TrialNet is an international network of people and organisations dedicated to the prevention of type 1 diabetes. People at risk of T1D may be eligible for screening or prevention studies, including in Australia. Find out more on their website.

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