title: [Ketoacidosis at time of diagnosis of type 1 diabetes in children and adolescents: effect of a national prevention campaign].
abstract: The aim of the study was to evaluate, after the first year of a national information campaign, the effect on the frequency and severity of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) in children and adolescents in France. The following data were collected during a 2-year period in people younger than 15 years of age at diagnosis of T1D, in 146 pediatric centers: age, sex, duration of symptoms, patient's previous care, clinical and biological signs, and family history of T1D. DKA was defined as pH<7.30 or bicarbonate<15mmol/L, severe DKA as pH<7.10 or bicarbonate <5mmol/L. During the 2nd year, an information campaign targeting health professionals and families was launched with the objective of reducing the time to diagnosis. Data were compared between the year before the campaign (year 0) and the first year of the campaign (year 1). The number of new cases of T1D was 1299 for year 0 and 1247 for year 1. Between year 0 and year 1, the rate of DKA decreased from 43.9% to 40.5% (P=0.08), exclusively due to the decrease of severe DKA from 14.8 to 11.4% (P=0.01). In the 0- to 5-year-old and 5- to 10-year-old age groups, the relative decrease in the rate of DKA was 13% and 15%, and 23% and 41% for severe DKA, respectively. In patients referred to the hospital by a pediatrician or who came at the family's initiative, the decrease was 34% and 7%, and 39% and 32% for severe DKA, respectively. No change was observed in the 10- to 15-year-old group or in those children who were referred by a general practitioner. In multivariate analyses, a higher DKA rate was associated with the young age of the child (<5 years), being hospitalized at the parents' initiative rather than being referred by a doctor, and the absence of a family history of T1D. A higher rate of severe DKA was associated with these last two factors but not with the child's age. The frequency of DKA at diagnosis of type 1 diabetes remains high in children and adolescents, but the first year of an information campaign decreased it. The results have also helped better define the strategy and targets of the continuing prevention campaign, to more efficiently reduce the morbidity and mortality of T1D at diagnosis in children and adolescents in France.
authors.affiliation: L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France. Electronic address: carine.choleau@ajd-educ.org.
authors.forename: C
authors.initials: C
authors.lastname: Choleau
authors.affiliation: L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et l'adolescent, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Maitre
authors.affiliation: Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France; Unité de recherche clinique Paris Centre, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Elie
authors.affiliation: Endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
authors.forename: P
authors.initials: P
authors.lastname: Barat
authors.affiliation: Unité d'endocrinologie - diabétologie pédiatriques, médecine pédiatrique, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Bertrand
authors.affiliation: Endocrinologie et diabétologie pédiatriques, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France.
authors.forename: M
authors.initials: M
authors.lastname: de Kerdanet
authors.affiliation: Diabétologie pédiatrique, pôle pédiatrique, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Tallec
authors.affiliation: Endocrinologie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69677 Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Nicolino
authors.affiliation: Endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, AP-HP, université Paris Diderot, Sorbonne Paris Cité, 48, boulevard Sérurier, 75019 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Tubiana-Rufi
authors.affiliation: Inserm CIC EC 05, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Levy-Marchal
authors.affiliation: L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Cahané
authors.affiliation: L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et l'adolescent, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Robert
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D013997:Time Factors