Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

Abstract

ObjectiveAfter a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013–2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign.DesignProspective observational study.SettingMulticentre study throughout Italy.InterventionNational awareness campaign started in November 2015 and held until December 2017.PatientsDuring 2016 and 2017 we collected data on all patients aged 0–18 years with new-onset diabetes.Main outcome measuresDKA (pH <7.30), severe DKA (pH <7.1), DKA in children below 6 years and DKA treatment according to the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) protocol were evaluated.ResultsRecords (n=2361) of children with newly diagnosed type 1 diabetes were collected from 58 out of 68 (85.3%) centres of the original survey participants and 100% of the previously surveyed tertiary centres. Overall, DKA was observed in 1124 patients, with an increased rate when compared with the previous survey (47.6% vs 38.5%, p=0.002), and severe DKA in 15.3%. In children below 6 years, DKA was observed in 323 out of 617 (52.5%) and severe DKA in 16.7%; in this age group, occurrence of DKA reduced by 21.3% (p=0.009). DKA treatment according to the ISPED guidelines was adopted in 95% of the centres, with a 27% improvement (p=0.025).ConclusionsDuring a 2-year awareness campaign, DKA at onset of diabetes in children and adolescents 0–18 years is still common and increased when compared with the 2013–2014 survey.

Outcomes of Children and Adolescents Admitted with Diabetic Ketoacidosis at Kenyatta National Hospital (KNH), Kenya

“…Cherubini reported DKA in 40.3% of children at diagnosis of TIDM and severe DKA in 11.2% of children [ 18 ]. The study by Rabbone reported severe DKA in 16.7% of the children aged < 6 years, and we reported a similar proportion of children with severe DKA in this age group [ 17 ]. Contrary to the findings from previous studies, we did not find any association between DKA severity, age, sex, type of insulin, missed insulin doses, and mortality, and this could be explained by the fact that the examination for mortality-associated factors was a secondary objective in our study and our sample size may not be adequate to assess for this.…”

“…This finding contradicts what was reported in the study conducted in Chennai, India, where infection was identified as a significant risk factor and a contributor to poor outcomes in children with DKA [ 16 ]. We reported severe DKA in 41.1% of children which is higher compared to the study done in Italy by Rabbone et al where severe DKA was reported in 15.3% of children aged <18 years [ 17 ]. It was also higher than what was reported in another study by Cherubini et al on DKA frequency at diagnosis of type 1 diabetes mellitus (T1DM) among children aged < 15 years.…”

Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014–2016 Nationwide Study of 2,679 Italian Children

“…A few studies have highlighted the effectiveness of awareness campaigns to prevent DKA at diagnosis of diabetes during last 20 years (8,10,(24)(25)(26). To date, due to methodological limitations of those studies, it is not possible to make a definitive conclusion on their effectiveness (8).…”

“…Based on this literature, the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) started a national awareness campaign for both the public and health professionals in 2014 (10). This campaign remains active and includes advertising posters and social media reminders (Facebook, Instagram, and advertisements on local television channels) for the public.…”

Kann die Ketoacidose bei pädiatrischen Patienten mit Manifestation eines Diabetes mellitus Typ 1 vermieden werden? Lehren aus der COVID-19-Pandemie

“…In Italien hatten öffentliche Aufklärungsmaßnahmen zu einer Reduktion der schweren DKA um 21,3 % bei jüngeren Kindern geführt, nicht aber bei Kindern über 6 Jahren [21].…”