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Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years
  1. Ivana Rabbone1,
  2. Giulio Maltoni2,
  3. Davide Tinti1,
  4. Stefano Zucchini2,
  5. Valentino Cherubini3,
  6. Riccardo Bonfanti4,
  7. Andrea Scaramuzza5
  8. On behalf of the Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED)
    1. 1Pediatric, Città della Salute e della Scienza di Torino, Turin, Italy
    2. 2Pediatric Department, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
    3. 3Regional Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, AOU Salesi Hospital, Ancona, Italy
    4. 4Pediatrics, Ospedale San Raffaele, Milano, Italy
    5. 5Pediatrics, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
    1. Correspondence to Dr Andrea Scaramuzza, Pediatrics, Azienda Socio Sanitaria Territoriale di Cremona, Cremona 26100, Italy; a.scaramuzza{at}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.

    • diabetes
    • epidemiology
    • diabetic ketoacidosis
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    Footnotes

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    • Collaborators Collaborators of the Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED). The following people were actively involved in the collection of data and have to be considered as collaborators of the paper: Riccardo Lera (Alessandria); Valentino Cherubini (Ancona); Adriana Bobbio (Aosta); Elvira Piccinno (Bari); Stefano Zucchini, Giulio Maltoni (Bologna); Petra Reinstadler (Bolzano); Barbara Felappi, Elena Prandi (Brescia); Francesco Gallo (Brindisi); Anna Paola Frongia, Carlo Ripoli (Cagliari); Donatella Lo Presti, Letizia Tomaselli (Catania); Giuliana Cardinale (Casarano); Filomena Andreina Stamati (Castrovillari); Felice Citriniti (Catanzaro); Tosca Suprani, Vanna Graziani (Cesena, Ravenna); Fiorella De Berardinis (Cetraro); Maria Zampolli (Como); Rosaria De Marco (Cosenza); Andrea Scaramuzza, Claudio Cavalli (Cremona); Nicola Lazzaro (Crotone); Valeria De Donno (Cuneo); Sonia Toni, Barbara Piccini, Lorenzo Lenzi (Florence); Benedetta Mainetti (Forlì); Maria Susanna Coccioli (Francavilla Fontana); Giuseppe d’Annunzio, Nicola Minuto (Genoa); Monica Aloe (Lamezia Terme); Sonia Lucchesi (Livorno); Dante Cirillo (Magenta); Silvia Sordelli (Mantova); Maurizio Delvecchio (Matera); Fortunato Lombardo, Giusy Salzano (Messina); Riccardo Bonfanti, Franco Meschi (Milano); Lorenzo Iughetti, Barbara Predieri (Modena); Adriana Franzese, Enza Mozzillo, Dario Iafusco (Naples); Francesco Cadario, Silvia Savastio (Novara); G Piredda (Olbia); Francesca Cardella (Palermo); Brunella Iovane (Parma); Valeria Calcaterra (Pavia); Maria Giulia Berioli (Perugia); Martina Biagioni (Pesaro); Emioli Randazzo (Pisa); Ippolita Patrizia Patera, Riccardo Schiaffini (Roma); Irene Rutigliano (San Giovanni Rotondo); Anna Lasagni (Reggio Emilia); Silvia Innaurato (Rovigo); Alberto Gaiero, Grazziella Fichera (Savona); Ivana Rabbone, Davide Tinti, Michela Trada (Turin); Lucia Guerraggio (Tradate); Vittoria Cauvin, Roberto Franceschi (Trento); Gianluca Tornese (Trieste); Alessandro Salvatoni (Varese); Marco Marigliano, Alberto Sabbion, Claudio Maffeis (Verona); Claudia Arnaldi (Viterbo).

    • Contributors IR, GM and SZ were responsible for the study design. All authors, as well as each of the person listed in the Collaborators section, were responsible for the conduct of the study and data collection. IR, DT, AS, VC and RB ran the data analysis and interpreted the data. IR and AS wrote the manuscript, and all authors read the paper and contributed to the discussion.

    • Funding We would like to thank Ascensia Italia for a non-conditional grant that supported the printing of the advertising posters.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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