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Arch Dis Child. 2019 Oct 9. pii: archdischild-2019-316903. doi: 10.1136/archdischild-2019-316903. [Epub ahead of print]

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

Author information

1
Pediatric, Città della Salute e della Scienza di Torino, Turin, Italy.
2
Pediatric Department, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
3
Regional Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, AOU Salesi Hospital, Ancona, Italy.
4
Pediatrics, Ospedale San Raffaele, Milano, Italy.
5
Pediatrics, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy a.scaramuzza@gmail.com.

Abstract

OBJECTIVE:

After 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.

DESIGN:

Prospective observational study.

SETTING:

Multicentre study throughout Italy.

INTERVENTION:

National awareness campaign started in November 2015 and held until December 2017.

PATIENTS:

During 2016 and 2017 we collected data on all patients aged 0-18 years with new-onset diabetes.

MAIN OUTCOME MEASURES:

DKA (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.

RESULTS:

Records (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).

CONCLUSIONS:

During 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.

KEYWORDS:

diabetes; diabetic ketoacidosis; epidemiology

Conflict of interest statement

Competing interests: None declared.

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