title: Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: Evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014.
abstract: BACKGROUND
  There has been little change in the incidence of diabetic ketoacidosis (DKA) in newly diagnosed type 1 diabetes mellitus (T1DM) in children and adolescents in most developed countries.
  
  
  OBJECTIVE
  To assess potentially modifiable antecedents of DKA in children <15 years of age with new onset T1DM.
  
  
  METHODS
  Retrospective review of prospectively collected data from a complete regional cohort of children with T1DM in Auckland (New Zealand) from 2010 to 2014. DKA and severity were defined according to the ISPAD 2014 guidelines.
  
  
  RESULTS
  A total of 263 children presented with new onset T1DM during the 5-year study period at 9.0 years of age (range 1.0-14.7), of whom 61% were NZ-European, 14% Maori, 13% Pacifica, and 11% other. A total of 71 patients (27%) were in DKA, including 31 mild, 20 moderate, and 20 severe DKA. DKA was associated with no family history of T1DM, higher glycated hemoglobin (HbA1c) values at presentation, self-presenting to secondary care, health care professional contacts in the 4 weeks before final presentation, and greater deprivation. Although a delay in referral from primary care for laboratory testing was common (81/216), only delay for more than 48 hours was associated with increased risk of DKA (11/22 > 48 h vs 12/59 referred at <48 h, P = .013).
  
  
  CONCLUSIONS
  These data suggest that in addition to lack of family awareness potentially modifiable risk factors for new onset DKA include prolonged delay for laboratory testing and a low index of medical suspicion for T1DM leading to delayed diagnosis.
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Eleanor R
authors.identifier: http://orcid.org/0000-0003-0656-7035
authors.initials: ER
authors.lastname: Gunn
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.|The Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Albert
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.|The Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hofman
authors.affiliation: The Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Cutfield
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.|Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Gunn
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.|The Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Jefferies
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D057210:Delayed Diagnosis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis* / Q000628:therapy / Q000652:urine; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000517:prevention & control*; D005190:Family; D005260:Female; D006029:Glycosuria / Q000453:epidemiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D012017:Referral and Consultation; D012041:Regional Medical Programs; D012189:Retrospective Studies; D012306:Risk
chemical_list: D001786:Blood Glucose
keywords: 
  T1DM
  ; children; diabetic ketoacidosis; insulin