Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review

Abstract

Aims/hypothesisType 1 diabetes is the most frequent endocrine disease in children, with 65,000 children diagnosed worldwide every year. Up to 80% of these children present with diabetic ketoacidosis (DKA), which is associated with both short-term risks and long-term consequences. This study aimed to characterise the worldwide variation in presentation of type 1 diabetes to inform future interventions to reduce this excess morbidity and mortality.MethodsThis was a systematic review of studies indexed on PubMed, EMBASE, Web of Science, Scopus or CINAHL before March 2011 that included unselected groups of children presenting with new-onset type 1 diabetes, reported the proportion presenting with DKA and used a definition of DKA based on measurement of pH or bicarbonate.ResultsSixty-five studies of cohorts comprising over 29,000 children in 31 countries were included. The frequency of DKA at diagnosis ranged from 12.8% to 80%, with highest frequencies in the United Arab Emirates, Saudi Arabia and Romania, and the lowest in Sweden, the Slovak Republic and Canada. Multivariable modelling showed the frequency of DKA was inversely associated with gross domestic product, latitude and background incidence of type 1 diabetes.Conclusions/interpretationThis is the first description of the variation in frequency of DKA at presentation of type 1 diabetes in children across countries. It demonstrates large variations that may, at least in part, be explained by different levels of disease awareness and healthcare provision and suggests ways to decrease the excess morbidity and mortality associated with DKA at diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-012-2690-2) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Changes in the Frequency of Diabetic Ketoacidosis in Type I Diabetes Mellitus Cases at Diagnosis: A Fifteen-Year Single Center Experience

“…Yeni tanı alan T1DM'li olgular arasında DKA görülme sıklığı %15-80 arasında değişmektedir (2)(3)(4). Tüm yaş gruplarında halen yüksek oranda rapor edilmekle birlikte, özellikle küçük yaş grubunun tanı ve tedavi gecikmesi nedeni ile daha yüksek oranda görülmektedir (5)(6)(7)(8).…”

Outcome of Patients with Diabetic Ketoacidosis in South of Iran

“…The dominant frequency was found in the developing countries. The lowest frequency was found in Sweden and Canada (4). It shows that education on the early symptoms of diabetes should be enhanced, so that new diabetic patients are not neglected, and they would not refer to hospitals having severe complications such as DKA.…”

“…[23] 134 patients (59.8%) participated in the present study were new cases of diabetes, and 90 cases were known cases of diabetes. [4] The prevalence of diabetic ketoacidosis as the first manifestation of diabetes varied from 12.8% to 80%. The dominant frequency was found in the developing countries.…”

“…The least frequencies were found in Canada, Sweden and Slovak Republic. [4] The primary goals in the treatment of these patients are as follow:…”

Mortality in childhood-onset type 1 diabetes: Nationwide population based data from Norway

“…It is reported two cases of death in children at diabetes onset during the first 48 h because of DKA with cerebral edema, during the seventies (6). The first description of the worldwide variation in the frequency of DKA at presentation of type 1 diabetes was recently published, reporting large variations that may, at least in part, be explained by different levels of disease awareness and healthcare provision (16). EURODIAB indicated that the frequency of DKA in Europe at diagnosis varied from 11% to 67% (17).…”