High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: A nationwide longitudinal study, 2004-2013

Valentino Cherubini, Edlira Skrami, Lucia Ferrito, Stefano Zucchini, Andrea Scaramuzza, Riccardo Bonfanti, Pietro Buono, Francesca Cardella, Vittoria Cauvin, Giovanni Chiari, Giuseppe D'Annunzio, Anna Paola Frongia, Dario Iafusco, Ippolita Patrizia Patera, Sonia Toni, Stefano Tumini, Ivana Rabbone, Fortunato Lombardo, Flavia Carle, Rosaria GesuitaRiccardo Lera, Livia De Luna, Antonella Gualtieri, Clara Zecchino, Elvira Piccinno, Petra Reinstadler, Elena Prandi, Francesco Gallo, Gianfranco Morganti, Carlo Ripoli, Alfonso La Loggia, Piera Scanu, Giuliana Cardinale, Letizia Grazia Tomaselli, Felice Citriniti, Nicola Lazzaro, Valeria De Donno, Benedetta Mainetti, Maria Susanna Coccioli, Rosella MacCioni, Ugo Marongiu, Mariella Bruzzese, Antonio Iannilli, Daniela Pardi, Santino Confetto, Angela Zanfardino, Lorenzo Iughetti, Adriana Franzese, Francesco Cadario, Anna Franca Milia, Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED)

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Abstract

This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004-2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis. Overall, 9,040 cases were ascertained. DKA frequency was 40.3% (95%CI: 39.3-41.4%), with 29.1% and 11.2% for mild/moderate and severe DKA, respectively. Severe DKA increased significantly during the period (OR = 1.03, 95%CI: 1.003-1.05). Younger-age children and children living in Southern Italy compared to Central Italy were at significantly higher risk of DKA and severe DKA. Family history of type 1 diabetes and residence in Sardinia compared to Central Italy were significantly associated with a lower probability of DKA and severe DKA. The high frequency of ketoacidosis in Italy over time and high variability among age groups and geographical area of residence, strongly suggests a continuing need for nationwide healthcare strategies to increase awareness of early detection of diabetes.

Original languageEnglish
Article number38844
JournalScientific Reports
Volume6
DOIs
Publication statusPublished - Dec 19 2016

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    Cherubini, V., Skrami, E., Ferrito, L., Zucchini, S., Scaramuzza, A., Bonfanti, R., Buono, P., Cardella, F., Cauvin, V., Chiari, G., D'Annunzio, G., Frongia, A. P., Iafusco, D., Patera, I. P., Toni, S., Tumini, S., Rabbone, I., Lombardo, F., Carle, F., ... Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) (2016). High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: A nationwide longitudinal study, 2004-2013. Scientific Reports, 6, [38844]. https://doi.org/10.1038/srep38844