P-463: Seasonal patterns and infectious triggers of pediatric diabetic ketoacidosis: a three-year study in a tertiary referral center
C Balbi, S Dutra, F Ramos, J Torres, I Bartolini, G Werneck, V Xavier, J Rajão, E Rodrigues, C Miranda, C MacielAbstract
Introduction
Diabetic ketoacidosis (DKA) is a severe acute complication of type 1 diabetes (T1D), frequently triggered by infections. Data on seasonal patterns and their relationship with new-onset versus previously diagnosed T1D in pediatric populations remain limited.
Objectives
To evaluate the impact of seasonality and infections on pediatric DKA, comparing new-onset T1D and previously diagnosed cases and to identify the most prevalent viral agents.
Methods
Retrospective observational study including pediatric patients admitted with DKA to a tertiary hospital in Belo Horizonte, Brazil, from June 2021 to June 2024. Patients with ICD-10 code E10.1 and DKA confirmed according to ISPAD 2022 criteria were included. Descriptive and comparative analyses were performed. Qualitative variables were expressed as absolute and relative frequencies, and associations were assessed using Fisher’s exact test (p<0.05).
Results
A total of 208 hospitalizations were analyzed. Infection was the main precipitating factor (30.8%), predominantly upper respiratory tract infections (62.5%), followed by gastroenteritis (9.4%), and pneumonia and dengue (3.1% each). Most admissions (56.3%) occurred during autumn and winter, with peaks in March, April, and June. New-onset diabetes cases showed higher incidence in March, April, and August, suggesting a stronger association with seasonal infectious triggers. Previously diagnosed patients had a more evenly distributed pattern, with peaks in April, June, and November, likely reflecting behavioral factors such as treatment adherence. Although not statistically significant, infection was more frequent in new-onset cases (36.6% vs. 26.1%, p=0.104). Viral infections, particularly influenza and SARS-CoV-2, were frequently identified.
Conclusions
DKA shows a clear seasonal pattern, especially in new-onset T1D, likely driven by infections. In previously diagnosed patients, DKA appears more influenced by adherence and psychosocial factors, supporting targeted prevention strategies.