Practical Classification approach for newly diagnosed diabetes onset with ketosis or ketoacidosis in children and adolescent patients

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.