**2. Epidemiology**

Worldwide, an estimated 65 000 children under 15 years old develop T1DM each year, and the global incidence in children continues to increase at a rate of 3% a year [12,13]. The cur‐ rent incidence in the UK is around 26/100 000 per year [14]. Patterson et al. were aimed to establish 15-year incidence trends for childhood T1DM in European centres with EURO‐ DIAB study. 29 311 new cases of T1DM were diagnosed in children before their 15th birth‐ day during a 15-year period between 1989-2003. The overall annual increase was 3.9% and the increases in the age groups 0-4 years, 5-9 years, and 10-14 years were found to be 5.4%, 4.3%, and 2.9% respectively. If present trends continue, prevalent cases younger than 15 years will rise by 70% in 2020 [15].

The incidence of DKA was found to be 5-8% in large community-based studies [16]. Ap‐ proximately 115 000 patients admitted to the hospital because of DKA in one year in USA

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[17]. In a Turkish study conducted among the patients with diabetic adults who admitted to the hospital, the ratio of T1DM was found to be 6.6% and DKA was 38% of the group [18]. There is wide geographic variation in the frequency of DKA at onset of diabetes. The ratio inversely correlates with the regional incidence of T1DM. Frequencies range from 15 to 70% in Europe, Australia, and North America [11,19-25]. The most occurrence ages of DKA are between the 18-44 years (56%), than 45-65 years (24%) continues with only 18% of patients <20 years of age. Two-thirds of DKA patients are considered to have T1DM and 34% to have type 2 diabetes. DKA is the most common cause of death in children and adolescents with T1DM. Half of all deaths in diabetic patients younger than 24 years of age are caused from DKA [26,27]. In adult subjects with DKA, the overall mortality is usually given <1% (13), however mortality rates may increase over 5% in the elders and in patients with concomi‐ tant life-threatening illnesses [28,29].

α and also white blood cell count (WBC), high sensitivity C-reactive protein (hs-CRP), growth hormone (GH) and cortisol in 38 newly diagnosed T1DM children with DKA (mean age 7.68±3.07 years), prior to, during and 120 hours after DKA management, with the aim to moni‐ tor their levels at different time-points and in different degrees of DKA severity. Prior to DKA management the levels of IL- 6, IL-8, IL-10,WBC and cortisol were elevated, but all parameters

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http://dx.doi.org/10.5772/53199

**Figure 1.** The pathogenesis causing to hyperglycemia and ketoacidosis in DKA (Data adapted from reference [17])

were reduced within 120 hours after DKA management [43].
