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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2012.97basm-1-97bLettersRE: Pattern of presentation in type 1 diabetic patients at the diabetes center of a university hospital Al-Mendalawi Mahmood D. Department of Pediatrics and Child Health, Al Kindy College of Medicine, Baghdad University, Baghdad, IraqCorrespondence: Professor Mahmood Dhahir Al-Mendalawi, MB, CH.B, DCH, FICMS (Pediatrics), P.O. Box 55302, Baghdad Post Office, Baghdad, Iraq, T.: +07703462470, mdalmendalawi@yahoo.comJan-Feb 2012 32 1 97 97 Copyright © 2012, Annals of Saudi Medicine2012This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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To the Editor: The frequency of diabetic ketoacidosis (DKA) at diagnosis (49.9%) reported by Al Rashed1 is still unacceptably high compared to the usual frequency of 20% to 25%. Al Rashed1 did not address factors contributing to that high frequency. However, I presume that the following three points might be contributory: 1) The consequence of the overall increased incidence of childhood diabetes mellitus in Saudi Arabia over the past 18 years,2 2) since Al Rashed1 did not address other demographic variables in his study like parental education and socioeconomic status, I presume that these factors might influence the frequency of DKA in his population as it was found that DKA at diagnosis was associated with lower family income and lower parental education,3 and 3) though children under the age of 5 years constituted only 3.5% of the studied population in the Al Rashed study,1 increasing evidence has emerged that difficulties in diagnosing type 1 diabetes mellitus (T1DM) are a significant cause of DKA development in children with new-onset T1DM. Patient age at presentation was found to be the main risk factor for delayed diagnosis, especially in children younger than 2 years.4 Moreover, diabetic children overall had more medical encounters before diagnosis than control subjects. Children with DKA were found to be less likely to have had relevant laboratory testing before diagnosis than children with diabetes without DKA.5 Increasing public awareness and greater pediatrician alertness are solicited to decrease the high rates of DKA in new onset type 1 diabetic children.
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REFERENCES
1 Al Rashed AM   Pattern of presentation in type 1 diabetic patients at the diabetes center of a university hospital Ann Saudi Med 2011 31 243 9 21623052 
2 Abduljabbar MA  Aljubeh JM  Amalraj A  Cherian MP   Incidence trends of childhood type 1 diabetes in eastern Saudi Arabia Saudi Med J 2010 31 413 8 20383419 
3 Rewers A  Klingensmith G  Davis C  Petitti DB  Pihoker C  Rodriguez B    Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study Pediatrics 2008 121 e1258 66 18450868 
4 Pawłowicz M  Birkholz D  Niedźwiecki M  Balcerska A   Difficulties or mistakes in diagnosing type 1 diabetes in children?: demographic factors influencing delayed diagnosis Pediatr Diabetes 2009 10 542 9 19496971 
5 Bui H  To T  Stein R  Fung K  Daneman D   Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr 2010 156 472 7 19962155