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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.

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



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.


Prospective observational study.


Multicentre study throughout Italy.


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


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


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.


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).


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.


diabetes; diabetic ketoacidosis; epidemiology

Conflict of interest statement

Competing interests: None declared.

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