Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.

Vanelli, Maurizio; Chiari, G; Ghizzoni, Lucia; Costi, G.; Giacalone, T; Chiarelli, Francesco

doi:10.2337/diacare.22.1.7

Cited by 287 publications

(242 citation statements)

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“…However, we did not observe a decrease in the frequency of mild or severe DKA at manifestation during the last 20 years. This is in contrast to reports from Finland [6] and Italy [9,10], where clear reductions in the frequency of DKA at diagnosis were reported. During the last 20 years in northern Finland, the prevalence of DKA has fallen from 29.5 to 18.9%.…”

Section: Discussioncontrasting

confidence: 99%

“…Some recent investigations have reported a decrease in DKA at onset [4,6,9], which may be due to an increase in medical awareness as a result of high background incidence [4,6], special information campaigns [9,10] or prevention programmes [6]. Because the incidence of childhood type 1 diabetes is increasing in most European countries [11] and numerous epidemiological publications have dealt with this increasing incidence, it might be expected that medical awareness in healthcare professionals should have improved in recent decades.…”

Section: Introductionmentioning

confidence: 99%

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Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

2010

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Aim The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)) on a population basis in the whole of Austria. Methods A prospective population-based incidence study (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH<7.3 and severe DKA as pH<7.1. Time trends were estimated using linear regression models. Results During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p< 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p<0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/ 100,000 (p<0.0001), no significant change in the prevalence of DKA at manifestation was observed. Conclusions The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

2010

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“…Shortening this latency period could be a winning preventive strategy. In the period of 1991-1997, we investigated this hypothesis in the province of Parma and demonstrated that, thanks to a school and physician campaign centered on the earliest symptom of diabetes (nocturnal enuresis in a "dry" child) as reported by 89% of parents, it was possible to prevent DKA (2). The key success of this campaign was due to a poster showing a child sleeping (potentially wetting the bed) as well as five attractive messages for parents: "Does your child drink and urinate more than usual?…”

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confidence: 99%

Campaign for Diabetic Ketoacidosis Prevention Still Effective 8 Years Later

et al. 2007

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“…The recent literature on specific causes of mortality in diabetic youth also suggests that a large fraction of current deaths are related to acute diabetes complications and are therefore theoretically preventable. The demonstration by Vanelli et al (34) that a regional education program was able to reduce the occurrence of DKA dramatically is an example that may be relevant to this problem in the U.S. In conclusion, diabetes mortality in U.S. children appeared to plateau for the period 1984 -1998; further reductions in mortality may depend on overcoming the obstacles to earlier treatment of uncontrolled diabetes and/or prevention of ketoacidosis and hypoglycemia.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Trends in Childhood Diabetes Mortality: 1968–1998

DiLiberti

Lorenz²

2001

Diabetes Care

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OBJECTIVE—In the context of recent improvements in type 1 diabetes therapy, to describe longitudinal trends in mortality attributable to childhood diabetes and to investigate socioeconomic and health services correlates of mortality. RESEARCH DESIGN AND METHODS—We extracted mortality data for 1968–1998 from National Center for Health Statistics files and covariates from the Bureau of Health Professions Area Resource File. Analytical techniques included linear and Poisson regression and standard descriptive statistics. RESULTS—Childhood (defined as 0–19 years of age) age-adjusted mortality from diabetes declined from 9.5 (1968) to 3.0 (1984) deaths per 10 million but remained relatively constant subsequently. All-cause childhood mortality, however, continued to decline. Older children experienced higher mortality rates, as did those living in counties with higher levels of unemployment. CONCLUSIONS—Despite recent improvements in therapy, diabetes-related mortality among children has not declined for 14 years. This finding may be partially attributable to sociodemographic factors influencing access to care, but the remaining mortality may defy available treatment methods. Reducing childhood diabetes mortality rates below the current apparent plateau may require new prevention and/or treatment strategies.

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Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.

Cited by 287 publications

References 0 publications

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

Campaign for Diabetic Ketoacidosis Prevention Still Effective 8 Years Later

Long-Term Trends in Childhood Diabetes Mortality: 1968–1998

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