title: Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes, and at diagnosis might represent delayed presentation. The extent and reasons for delays are unclear, but identifying and targeting factors associated with DKA could reduce this incidence.
  
  
  OBJECTIVE
  To compare the patient pathway before diagnosis of type 1 diabetes mellitus (T1DM) in children presenting with DKA and non-acidotic hyperglycaemia.
  
  
  METHODS
  Over a 3-month period, children newly diagnosed with T1DM were identified on admission to UK hospitals. Parents and medical teams completed a questionnaire about events before diagnosis.
  
  
  RESULTS
  Data were available for 261 children (54% male), median age 10.3y (range 0.8-16.6 y). 25% presented with DKA, but more commonly in children <2y (80% vs 23%, p<0.001). Fewer children with DKA reported polyuria (76% vs 86%) or polydipsia (86% vs 94%) (both p<0.05), but more reported fatigue (74% vs 52%) and weight loss (75% vs 54%) (both p<0.01). 24% of children had multiple healthcare professional (HCP) contacts, and these children had lower pH on admission. 46% of children with a delayed presentation to secondary care had non-urgent investigations. 64% of parents had considered a diagnosis of diabetes, and these children were less likely to present with DKA (13% vs 47%, p<0.001).
  
  
  CONCLUSIONS
  Multiple HCP contacts increased risk of presentation in DKA, whereas, parental awareness of diabetes was protective. Improved public and health professional education targeting non-classical symptoms, awareness of diabetes in under 2 y, and point-of-care testing could reduce DKA at diagnosis of diabetes.
authors.affiliation: Department of Paediatric Endocrinology, University Hospital Southampton, , Southampton, UK.
authors.forename: K
authors.initials: K
authors.lastname: Lokulo-Sodipe
authors.forename: R J
authors.initials: RJ
authors.lastname: Moon
authors.forename: J A
authors.initials: JA
authors.lastname: Edge
authors.forename: J H
authors.initials: JH
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000517:prevention & control*; D005221:Fatigue / Q000175:diagnosis; D005260:Female; D006282:Health Personnel; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis; D015994:Incidence; D007223:Infant; D008297:Male; D010290:Parents; D059606:Polydipsia / Q000175:diagnosis; D011141:Polyuria / Q000175:diagnosis; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss
keywords: Diabetes; children; diabetic ketoacidosis; diagnosis; presentation