medwireNews: A major analysis covering three continents suggests that diabetic ketoacidosis (DKA) remains unacceptably common among children newly identified with type 1 diabetes and shows few signs of improving.
The overall prevalence of DKA at type 1 diabetes diagnosis was 29.9% among the 59,000 children studied, with prevalence varying considerably between the 13 countries and increasing slightly during the study period of 2006 to 2016.
Julia Grimsmann (University of Ulm, Germany) and co-workers say their data “must be considered worrying for all countries”, particularly those with advanced healthcare systems. They suggest more objective evaluation of DKA, including venous pH, is needed to better estimate the condition in these children.
The team adds: “These findings should be considered as a call for action to put more effort into promoting an earlier diagnosis of diabetes to prevent DKA in children and adolescents worldwide.”
The researchers collected information from population-based registries, nationwide clinical records, and a multicentre study. The countries involved included Austria, the Czech Republic, Denmark, Germany, Italy, Luxembourg, Norway, Slovenia, Sweden, Wales, Australia, New Zealand and the USA.
The median age at which the children were diagnosed with new-onset type 1 diabetes was 9.0 years, and 52.9% were boys.
DKA prevalence at diabetes diagnosis was lowest in Sweden and Denmark, at a corresponding 19.5% and 20.8% when standardized by sex and age across the whole study population, and highest in Luxembourg and Italy, at 43.8% and 41.2%, respectively.
During the 11 years of study, there was a marked increase in DKA at diagnosis in the USA and Australia, while in Germany the increase was small but statistically significant due to the large number of patients included from this country.
The proportion of children with DKA at diabetes diagnosis decreased in Italy during the study period, but Italy also had one of the highest DKA prevalences of all the countries.
Nearly all countries showed a slightly greater proportion of girls than boys presenting with DKA, with a prevalence ratio of 1.038 overall, and a significantly higher ratio was observed in Denmark and Slovenia, at 1.179 and 1.411, respectively. The exception was Wales, where boys more often presented with DKA at diabetes diagnosis and the female-to-male sex prevalence ratio was 0.785.
In most countries, preschool children, adolescents, and children from ethnic minority groups were at greatest risk for DKA at diabetes diagnosis.
“Effective prevention campaigns should be targeted to reach a high percentage of the general population and healthcare professionals, should be repeated and prolonged over time, and should monitor all factors influencing the occurrence of DKA,” the researchers report in Diabetologia.
“Preschool screening for islet autoantibodies in the general population might be useful to prevent DKA at diagnosis, as shown in a public health screening programme among children aged 2–5 years in Bavaria, Germany, in which the prevalence of DKA at diagnosis was less than 5%.
“Moreover, screening costs were kept low by using a relatively inexpensive and sensitive method.”
By Anita Chakraverty
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Diabetologia 2020; doi:10.1007/s00125-020-05152-1