title: Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted.
abstract: OBJECTIVE
  To assess the frequency and severity of diabetic ketoacidosis (DKA) at disease onset in children newly diagnosed with autoimmune type 1 diabetes (T1D) in Istanbul in the last decade. Also, to evaluate the potential contribution of the national diabetes awareness programme (NDAP) initiated in 2010.
  
  
  METHODS
  Four hundred and one consecutive children (mean ± standard deviation, age 8.1 ± 4.1 years) with a diagnosis of autoimmune T1D were evaluated retrospectively with respect to demographic, clinical, and laboratory data in relation to DKA at disease onset. The possible impact of NDAP on the rate of DKA at disease onset in the last 2 years was also evaluated by comparing the data related to the time intervals before and after the onset of the programme. The results were evaluated at 95% confidence interval and significance was granted for p ≤ 0.05.
  
  
  RESULTS
  The overall frequency of DKA at disease onset was 44.2%, with a significant trend for decline in rate of DKA at disease onset in the last decade (p=0.0001). There were no significant differences in proportions of newly diagnosed T1D patients with severe or moderate DKA over time. Mean body mass index standard deviation score tended to increase in the last decade, but not significantly (p=0.09). When the time intervals before and after the onset of NDAP were evaluated, there was a more than two-fold decrease in rate of DKA (from 49.3% to 23.9%) (p<0.0001).
  
  
  CONCLUSIONS
  The frequency of a DKA event at onset of T1D is still high in Istanbul children despite a decreasing trend in the last decade. NDAP may significantly contribute to the reduction in rate of DKA.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uçar
authors.forename: Nurçin
authors.initials: N
authors.lastname: Saka
authors.forename: Firdevs
authors.initials: F
authors.lastname: Baş
authors.forename: Mine
authors.initials: M
authors.lastname: Sukur
authors.forename: Sukran
authors.initials: S
authors.lastname: Poyrazoğlu
authors.forename: Feyza
authors.initials: F
authors.lastname: Darendeliler
authors.forename: Ruveyde
authors.initials: R
authors.lastname: Bundak
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D007662:Ketosis / Q000150:complications*; D008297:Male; D012720:Severity of Illness Index; D014421:Turkey