Microbiota, epidemiological and nutritional factors related to ketoacidosis at the onset of type 1 diabetes

Aims: The incidence of type 1 diabetes has increased over the last decades. The pathological pathway is not yet clear, even if genetic and environmental risk factors are known. An early diagnosis can avoid ketoacidosis and its complications. This work aims to discuss the determinants of both ketoacidosis at the onset and access by hospital emergency departments without a suspected diagnosis. Methods: An observational bi-centric prospective study was conducted in Northern Italy, on a paediatric population including Italian and migrant patients at the diabetes onset. Seventy-four type 1 diabetes patients, both Italian and migrant, were included in the study. Anthropometric, socio-economic, behavioural, clinical data were collected, and microbiota analyses were performed using stool samples. Results: Regular physical activity is associated with lower ketoacidosis incidence at onset (OR 0.33 95% CI 0.12–0.95 p < 0.05), as is higher blood vitamin D level (OR 0.92 95% CI 0.85–0.99 p < 0.05). Moreover, a higher weaning age (OR 0.49 95% CI 0.27–0.89 p < 0.05), higher vitamin D level (OR 0.90 95% CI 0.83–0.98 p < 0.05) and a higher level of Akkermansia muciniphila (OR 0.46 95% CI 0.25–0.87 p < 0.05) are associated factors to lower frequency of type 1 diabetes onset without a suspected diagnosis. Diabetes migrant status is not a risk factor for severe type 1 diabetes onset; on the other hand, some protective factors are significantly more diffused among Italians, such as regular sport activity and non-critical vitamin D levels. Conclusion: Behavioural and nutritional data, such as microbiota bio-indicators, seem to be useful to identify an at-risk population to prevent ketoacidosis and its severe complications.