title: High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: a nationwide longitudinal study, 2004-2013.
abstract: This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004-2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis. Overall, 9,040 cases were ascertained. DKA frequency was 40.3% (95%CI: 39.3-41.4%), with 29.1% and 11.2% for mild/moderate and severe DKA, respectively. Severe DKA increased significantly during the period (OR = 1.03, 95%CI: 1.003-1.05). Younger-age children and children living in Southern Italy compared to Central Italy were at significantly higher risk of DKA and severe DKA. Family history of type 1 diabetes and residence in Sardinia compared to Central Italy were significantly associated with a lower probability of DKA and severe DKA. The high frequency of ketoacidosis in Italy over time and high variability among age groups and geographical area of residence, strongly suggests a continuing need for nationwide healthcare strategies to increase awareness of early detection of diabetes.
authors.affiliation: Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Cherubini
authors.affiliation: Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Edlira
authors.initials: E
authors.lastname: Skrami
authors.affiliation: Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ferrito
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.affiliation: Department of Pediatrics, Azienda Ospedaliera, "Ospedale Luigi Sacco", University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Scaramuzza
authors.affiliation: Department of Pediatrics, Endocrine Unit, Scientific Institute Hospital San Raffaele, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonfanti
authors.affiliation: UOSD Pediatric Diabetology, ASL NA2 Nord, Via Corrado Alvaro 8, Monteruscello, 80072 Pozzuoli, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Buono
authors.affiliation: Department of Pediatrics, U.O.S. Pediatric Diabetology, ARNAS Civico Di Cristina, Via Benedettini 1, 90134 Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardella
authors.affiliation: Pediatric Unit, S. Chiara Hospital, Largo Medaglie d'Oro 9, 38122 Trento, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cauvin
authors.affiliation: Postgraduate School of Pediatrics, University of Parma, Viale Gramsci 14, 43100 Parma, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Chiari
authors.affiliation: Giannina Gaslini Institute, Via Gaslini 5, 16147 Genova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D Annunzio
authors.affiliation: Unit of Pediatric Diabetes, Brotzu Hospital, Piazzale Ricchi 1, 09134 Cagliari, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Frongia
authors.affiliation: Department of Pediatrics, Second University of Naples, Via S. Andrea delle Dame 4, 80138 Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.affiliation: Endocrinology and Diabetes Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Ippolita Patrizia
authors.initials: IP
authors.lastname: Patera
authors.affiliation: Juvenile Diabetes Center, Anna Meyer Children's Hospital, Via Pieraccini 24, 50132 Florence, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Toni
authors.affiliation: Center of Pediatric Diabetology, University of Chieti, 66100 Chieti, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tumini
authors.affiliation: Department of Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Rabbone
authors.affiliation: Department of Pediatrics, Messina Hospital, Messina, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Lombardo
authors.affiliation: Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Carle
authors.affiliation: Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
mesh_terms: D000293:Adolescent; D000367:Age Factors; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male