Abstract
Background
Distinguishing diabetes diagnosis is fundamental to ensuring proper management of patients, but has been challenging, especially in newly diagnosed diabetes onset with ketosis or ketoacidosis.
Methods
A retrospective analysis was conducted on medical records from 2017/1/1 to 2020/4/30 among children and adolescents with new-onset diabetes accompanied with ketosis or ketoacidosis. Data was collected at diabetes onset and 2 years after discharge. Patients were classified as type 1 or 2 diabetes (T1DM; T2DM) based on the patient's medication and final diagnosis. The best diagnostic cut-off point was determined using receiver operating characteristic curves (ROCs) between T1DM and T2DM.
Results
Among 153 children and adolescents, 78 patients (51.0%) were diagnosed as T1DM and 75 patients (49.0%) were diagnosed as T2DM after 2 years of follow-up. There were significant differences in sex, age, family history, BMI, systolic and diastolic blood pressure, lipids, uric acid (UA), C-peptide, combined fatty liver ratio and any islet autoantibody-positive ratio at the time of onset (P < 0.05). In the ROC analysis, fatty liver, SBP, BMI, fasting/1-h/2-h C peptide at the time of onset performed well on diagnostic typing (ROC AUC = 0.79, 0.83, 0.92, 0.94, 0.96, and 0.95 respectively; Optimal cut point = 1.5, 110.5, 21.0, 0.5, 1.0 and 2.0).
Conclusions
This study provides a practical clinical approach to the diagnosis and classification of diabetes. Caution is needed in C-peptide, BMI, SBP and fatty liver at the time of onset, which have effective diagnostic values.