P-507: Changing epidemiology of pediatric diabetic ketoacidosis over 16 years: lessons from a Moroccan tertiary center
S El Moudden, S Abourazzak, M HidaAbstract
Introduction
Diabetic ketoacidosis (DKA) remains a serious and still frequent presentation of childhood type 1 diabetes. In many children, it reflects a delayed recognition of early diabetic symptoms. Studying long-term trends may help identify the most vulnerable groups and improve prevention
Objectives
To describe the epidemiological changes in pediatric DKA between 2009 and 2024 and identify factors associated with delayed diagnosis and severe presentation.
Methods
We conducted a retrospective descriptive study including children admitted for DKA to the Pediatric Department of Hassan II University Hospital, Fez, Morocco, from January 2009 to December 2024. Demographic, clinical, seasonal and socio-economic data were analyzed.
Results
A total of 530 children were included. Girls represented 53% of cases. The mean age was 6 years and 4 months, ranging from 2 months to 15 years. Over time, DKA increasingly affected children younger than 5 years, particularly from 2018 to 2024, whereas older children predominated in earlier years. DKA was inaugural in 67% of cases, and severe forms accounted for 37%, mainly among younger children. Classic symptoms of diabetes were reported in 89% of patients, but the mean duration of symptoms before diagnosis was 28.65 days, suggesting missed opportunities for earlier recognition. A family history of diabetes was found in 44% of cases. Low socio-economic status was present in 54%, and 73% of children lived in urban areas. A winter predominance was observed, especially in November, December and January.
Conclusions
This 16-year experience shows that pediatric DKA remains a frequent and largely preventable mode of diabetes presentation in our setting. The recent increase among children under 5 years and the high rate of severe forms are concerning. Earlier recognition of diabetes symptoms, public awareness and training of frontline healthcare providers are essential to reduce diagnostic delay and prevent severe DKA.