title: Prevalence of ketoacidosis at diagnosis of childhood onset Type 1 diabetes in Wales from 1991 to 2009 and effect of a publicity campaign.
abstract: OBJECTIVE
  To determine the proportion of cases of childhood Type 1 diabetes that present with ketoacidosis and any temporal trend. To assess the impact of a publicity campaign promoting earlier diagnosis.
  
  
  METHODS
  We used an all-Wales register of incident cases with data on 2046 children from 1991 to 2009. The proportion with ketoacidosis at diagnosis was compared with the Yorkshire Childhood Diabetes Register. On World Diabetes Day posters were sent to every pharmacy, school and general practitioner surgery across Wales and radio interviews given. A questionnaire survey was conducted in Gwent to assess penetrance of the campaign.
  
  
  RESULTS
  Annually, in 1991-2009 the proportion presenting with ketoacidosis varied between 20% and 33% (mean 25%) with no change over time. Similar proportions occurred in Yorkshire. Ketoacidosis was more common before age 5 years (37% of cases) than at age 5-9 years (20%) or 10-14 years (23%) (P < 0.001). From November 2006-2007 30% of cases presented with ketoacidosis and from November 2007-2008 25% cases presented with ketoacidosis. After the campaign (November 2008-2009) 26% presented with ketoacidosis (P = 0.72). The information had reached a low proportion of families. General practitioners referred immediately cases that presented to them.
  
  
  CONCLUSIONS
  Over 20 years in Wales there has been no change in the proportion of children with Type 1 diabetes initially presenting with ketoacidosis. This presentation occurs in a higher proportion of new cases aged under 5 years. Publicity to increase awareness did not reduce the proportion with ketoacidosis at diagnosis in Wales. We need to get the educational message through to parents to reduce ketoacidosis at presentation.
authors.affiliation: Centre for Endocrine & Diabetes Sciences, University Hospital of Wales, Cardiff, UK. lansdownaj@doctors.org.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansdown
authors.forename: J
authors.initials: J
authors.lastname: Barton
authors.forename: J
authors.initials: J
authors.lastname: Warner
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: J W
authors.initials: JW
authors.lastname: Gregory
authors.forename: J N
authors.initials: JN
authors.lastname: Harvey
authors.forename: L
authors.initials: L
authors.lastname: Lowes
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007223:Infant; D008297:Male; D008389:Marketing of Health Services / Q000379:methods*; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D014852:Wales / Q000453:epidemiology