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Research Article
Prevalence of ketoacidosis at diagnosis of childhood onset Type 1 diabetes in Wales from 1991 to 2009 and effect of a publicity campaign

A. J. Lansdown, J. Barton, J. Warner, D. Williams, J. W. Gregory, J. N. Harvey and L. Lowes

Diabetic Medicine, 2012, 29(12), 1506-1509. DOI: 10.1111/j.1464-5491.2012.03638.x

Abstract

Aims  To determine the proportion of cases of childhood Type 1 diabetes that present with ketoacidosis and any temporal trend. To assess the impact of a publicity campaign promoting earlier diagnosis.

Methods  We used an all-Wales register of incident cases with data on 2046 children from 1991 to 2009. The proportion with ketoacidosis at diagnosis was compared with the Yorkshire Childhood Diabetes Register. On World Diabetes Day posters were sent to every pharmacy, school and general practitioner surgery across Wales and radio interviews given. A questionnaire survey was conducted in Gwent to assess penetrance of the campaign.

Results  Annually, in 1991-2009 the proportion presenting with ketoacidosis varied between 20% and 33% (mean 25%) with no change over time. Similar proportions occurred in Yorkshire. Ketoacidosis was more common before age 5 years (37% of cases) than at age 5-9 years (20%) or 10-14 years (23%) (P < 0.001). From November 2006-2007 30% of cases presented with ketoacidosis and from November 2007-2008 25% cases presented with ketoacidosis. After the campaign (November 2008-2009) 26% presented with ketoacidosis (P = 0.72). The information had reached a low proportion of families. General practitioners referred immediately cases that presented to them.

Conclusions  Over 20 years in Wales there has been no change in the proportion of children with Type 1 diabetes initially presenting with ketoacidosis. This presentation occurs in a higher proportion of new cases aged under 5 years. Publicity to increase awareness did not reduce the proportion with ketoacidosis at diagnosis in Wales. We need to get the educational message through to parents to reduce ketoacidosis at presentation.

ASCI-ID: 109-1184

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Evaluating the cost-effectiveness of reduced mild hypoglycaemia in subjects with Type 1 diabetes treated with insulin detemir or NPH insulin in Denmark, Sweden, Finland and the Netherlands

Diabetic Medicine, 2012, 29(3), 303-312. DOI: 10.1111/j.1464-5491.2011.03461.x

Evaluation of placental growth factor and soluble Fms-like tyrosine kinase 1 as predictors of all-cause and cardiovascular mortality in patients with Type 1 diabetes with and without diabetic nephropathy

Diabetic Medicine, 2012, 29(3), 337-344. DOI: 10.1111/j.1464-5491.2011.03482.x

Alcohol-associated risks for young adults with Type 1 diabetes: a narrative review

Diabetic Medicine, 2012, 29(4), 434-440. DOI: 10.1111/j.1464-5491.2012.03579.x

Increased serum concentrations of adhesion molecules but not of chemokines in patients with Type 2 diabetes compared with patients with Type 1 diabetes and latent autoimmune diabetes in adult age: Action LADA 5

Diabetic Medicine, 2012, 29(4), 470-478. DOI: 10.1111/j.1464-5491.2011.03546.x

Transitions in care: support group for young adults with Type 1 diabetes

Diabetic Medicine, 2012, 29(4), 522-525. DOI: 10.1111/j.1464-5491.2011.03537.x

Re-examining a measure of diabetes-related burden in parents of young people with Type 1 diabetes: the Problem Areas in Diabetes Survey - Parent Revised version (PAID-PR)

Diabetic Medicine, 2012, 29(4), 526-530. DOI: 10.1111/j.1464-5491.2011.03434.x

Hypoglycaemia during pregnancy in women with Type 1 diabetes

Diabetic Medicine, 2012, 29(5), 558-566. DOI: 10.1111/j.1464-5491.2012.03604.x

Poor numeracy skills are associated with glycaemic control in Type 1 diabetes

Diabetic Medicine, 2012, 29(5), 662-669. DOI: 10.1111/j.1464-5491.2011.03466.x

Dose Adjustment for Normal Eating (DAFNE) in routine clinical practice: who benefits?

Diabetic Medicine, 2012, 29(5), 670-676. DOI: 10.1111/j.1464-5491.2011.03479.x

Working with young adults with Type 1 diabetes: Views of a multidisciplinary care team and implications for service delivery

Diabetic Medicine, 2012, 29(5), 677-681. DOI: 10.1111/j.1464-5491.2012.03601.x

Improved health status with insulin degludec compared with insulin glargine in people with Type 1 diabetes

Diabetic Medicine, 2012, 29(6), 716-720. DOI: 10.1111/j.1464-5491.2011.03547.x

Association between age, IL-10, IFNγ, stimulated C-peptide and disease progression in children with newly diagnosed Type 1 diabetes

Diabetic Medicine, 2012, 29(6), 734-741. DOI: 10.1111/j.1464-5491.2011.03544.x

Glycaemic control and weight 7 years after Dose Adjustment For Normal Eating (DAFNE) structured education in Type 1 diabetes

Diabetic Medicine, 2012, 29(6), 807-812. DOI: 10.1111/j.1464-5491.2011.03525.x

Type 1 diabetes and measles, mumps and rubella childhood infections within the Italian Insulin-dependent Diabetes Registry

Diabetic Medicine, 2012, 29(6), 761-766. DOI: 10.1111/j.1464-5491.2011.03529.x

Metabolic regulation during constant moderate physical exertion in extreme conditions in Type 1 diabetes

Diabetic Medicine, 2012, 29(6), 822-826. DOI: 10.1111/j.1464-5491.2011.03453.x

Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen

Diabetic Medicine, 2012, 29(7), 926-932. DOI: 10.1111/j.1464-5491.2012.03646.x

Arterial stiffness and endothelial dysfunction independently and synergistically predict cardiovascular and renal outcome in patients with type 1 diabetes

Diabetic Medicine, 2012, 29(8), 990-994. DOI: 10.1111/j.1464-5491.2012.03633.x

The effect of rising vs. falling glucose level on amperometric glucose sensor lag and accuracy in Type 1 diabetes

Diabetic Medicine, 2012, 29(8), 1067-1073. DOI: 10.1111/j.1464-5491.2011.03545.x

Experiences of using blood glucose targets when following an intensive insulin regimen: a qualitative longitudinal investigation involving patients with Type 1 diabetes

Diabetic Medicine, 2012, 29(8), 1079-1084. DOI: 10.1111/j.1464-5491.2012.03670.x

Temporal changes in the diagnosis of type 1 diabetes by diabetic ketoacidosis in Brazil: A nationwide survey

Diabetic Medicine, 2012, 29(9), 1142-1147. DOI: 10.1111/j.1464-5491.2012.03590.x

Does severe hypoglycaemia influence microvascular complications in Type 1 diabetes? An analysis of the Diabetes Control and Complications Trial database

Diabetic Medicine, 2012, 29(9), 1195-1198. DOI: 10.1111/j.1464-5491.2012.03612.x

Number and sex ratio of children and impact of parental diabetes in individuals with Type 1 diabetes

Diabetic Medicine, 2012, 29(10), 1268-1271. DOI: 10.1111/j.1464-5491.2012.03618.x

Type 1 diabetes in pre-school children - long-term metabolic control, associated autoimmunity and complications

Diabetic Medicine, 2012, 29(10), 1291-1296. DOI: 10.1111/j.1464-5491.2012.03682.x

Facilitating children's contributions in clinic? Findings from an in-depth qualitative study with children with Type 1 diabetes

Diabetic Medicine, 2012, 29(10), 1303-1310. DOI: 10.1111/j.1464-5491.2012.03714.x

Setting research priorities for Type 1 diabetes

Diabetic Medicine, 2012, 29(10), 1321-1326. DOI: 10.1111/j.1464-5491.2012.03755.x

Femoral-gluteal adiposity is not associated with insulin sensitivity in Type 1 diabetes

Diabetic Medicine, 2012, 29(11), 1407-1411. DOI: 10.1111/j.1464-5491.2012.03728.x

The risk of proliferative retinopathy in siblings with Type 1 diabetes

Diabetic Medicine, 2012, 29(12), 1567-1573. DOI: 10.1111/j.1464-5491.2012.03768.x

Type 1 diabetes from bench to bedside; a dedication to George Eisenbarth

Diabetic Medicine, 2013, 30(2), 133-133. DOI: 10.1111/dme.12101

The multiple origins of Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 135-146. DOI: 10.1111/dme.12081

Immunological pathways to β-cell damage in Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 147-154. DOI: 10.1111/dme.12085

The environment and the origins of islet autoimmunity and Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 155-160. DOI: 10.1111/dme.12099

Primary and secondary prevention of Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 161-169. DOI: 10.1111/dme.12100

Potential role of non-insulin adjunct therapy in Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 179-188. DOI: 10.1111/j.1464-5491.2012.03744.x

Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis

Diabetic Medicine, 2013, 30(2), 189-198. DOI: 10.1111/j.1464-5491.2012.03771.x

Prevalence of depression among young people with Type 1 diabetes: a systematic review

Diabetic Medicine, 2013, 30(2), 199-208. DOI: 10.1111/j.1464-5491.2012.03721.x

Self-treating hypoglycaemia: a longitudinal qualitative investigation of the experiences and views of people with Type 1 diabetes

Diabetic Medicine, 2013, 30(2), 209-215. DOI: 10.1111/dme.12007

Insulin analogues in children with Type 1 diabetes: a 52-week randomized clinical trial

Diabetic Medicine, 2013, 30(2), 216-225. DOI: 10.1111/dme.12041

The impact of blood glucose and HbA1c goals on glycaemic control in children and adolescents with Type 1 diabetes

Diabetic Medicine, 2013, 30(3), 333-337. DOI: 10.1111/dme.12083

The effect of insulin intensification in children and young persons with Type 1 diabetes differs in relation to ethnic group; a prospective observational study

Diabetic Medicine, 2013, 30(4), 495-501. DOI: 10.1111/dme.12022

Urinary sulphate excretion and progression of diabetic nephropathy in Type 1 diabetes

Diabetic Medicine, 2013, 30(5), 563-566. DOI: 10.1111/dme.12131

Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes

Diabetic Medicine, 2013, 30(5), 610-615. DOI: 10.1111/dme.12067

Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes

Diabetic Medicine, 2013, 30(5), 567-573. DOI: 10.1111/dme.12127

HLA class II gene associations in African American Type 1 diabetes reveal a protective HLA-DRB1*03 haplotype

Diabetic Medicine, 2013, 30(6), 710-716. DOI: 10.1111/dme.12148

Type 1 diabetes structured education: what are the core self-management behaviours?

Diabetic Medicine, 2013, 30(6), 724-730. DOI: 10.1111/dme.12164

Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review

Diabetic Medicine, 2013, 30(7), 818-824. DOI: 10.1111/dme.12136

Vitamin D levels during and after resolution of ketoacidosis in children with new onset Type 1 diabetes

Diabetic Medicine, 2013, 30(7), 829-834. DOI: 10.1111/dme.12200

Compromised quality of life in patients with both Type 1 diabetes mellitus and coeliac disease

Diabetic Medicine, 2013, 30(7), 835-839. DOI: 10.1111/dme.12205

Serological testing for coeliac disease in Type 1 diabetes mellitus: is immunoglobulin A level measurement necessary?

Diabetic Medicine, 2013, 30(7), 840-845. DOI: 10.1111/dme.12163

Blood pressure levels but not hypertensive complications have increased in Type 1 diabetes pregnancies during 1989-2010

Diabetic Medicine, 2013, 30(9), 1087-1093. DOI: 10.1111/dme.12224

Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents

Diabetic Medicine, 2013, 30(9), 1126-1131. DOI: 10.1111/dme.12247

Diabetes distress in Type 1 diabetes-a new measurement fit for purpose

Diabetic Medicine, 2013, 30(9), 1132-1139. DOI: 10.1111/dme.12241

Disclosure of psychosocial stressors affecting diabetes care among uninsured young adults with Type 1 diabetes

Diabetic Medicine, 2013, 30(9), 1140-1144. DOI: 10.1111/dme.12248

Vitamin D in youth with Type 1 diabetes: prevalence of insufficiency and association with insulin resistance in the SEARCH Nutrition Ancillary Study

Diabetic Medicine, 2013, 30(11), 1324-1332. DOI: 10.1111/dme.12297

Concordance of retinopathy and nephropathy over time in Type 1 diabetes: an analysis of data from the Diabetes Control and Complications Trial

Diabetic Medicine, 2013, 30(11), 1333-1341. DOI: 10.1111/dme.12296

Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents

Diabetic Medicine, 2013, 30(11), 1360-1366. DOI: 10.1111/dme.12252

Real-time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes - observations from a randomized controlled trial

Diabetic Medicine, 2013, 30(11), 1374-1381. DOI: 10.1111/dme.12246

Paediatric estimated average glucose in children with Type 1 diabetes

Diabetic Medicine, 2014, 31(1), 36-39. DOI: 10.1111/dme.12285

Impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses: a qualitative study

Diabetic Medicine, 2014, 31(1), 47-54. DOI: 10.1111/dme.12276

Diabetes-Oriented Learning Family Intervention (DOLFIN): a feasibility study evaluating an intervention for carers of young persons with Type 1 diabetes

Diabetic Medicine, 2014, 31(1), 55-60. DOI: 10.1111/dme.12333

Developing a hierarchy of needs for Type 1 diabetes

Diabetic Medicine, 2014, 31(1), 61-67. DOI: 10.1111/dme.12284

Patients with Type 1 diabetes consuming alcoholic spirits have an increased risk of microvascular complications

Diabetic Medicine, 2014, 31(2), 156-164. DOI: 10.1111/dme.12307

The dynamic changes of zinc transporter 8 autoantibodies in Czech children from the onset of Type 1 diabetes mellitus

Diabetic Medicine, 2014, 31(2), 165-171. DOI: 10.1111/dme.12308

A novel single nucleotide polymorphism in the protein tyrosine phosphatase N22 gene (PTPN22) is associated with Type 1 diabetes in a Chinese population

Diabetic Medicine, 2014, 31(2), 219-226. DOI: 10.1111/dme.12331

Medical and psychological outcomes for young adults with Type 1 diabetes: no improvement despite recent advances in diabetes care

Diabetic Medicine, 2014, 31(2), 227-231. DOI: 10.1111/dme.12305

Urinary type IV collagen as a predictor for the incidence of microalbuminuria in young patients with Type 1 diabetes

Diabetic Medicine, 2014, 31(2), 213-218. DOI: 10.1111/dme.12317

Real-time continuous glucose monitoring as a tool to prevent severe hypoglycaemia in selected pregnant women with Type 1 diabetes - an observational study

Diabetic Medicine, 2014, 31(3), 352-356. DOI: 10.1111/dme.12383

Epidemiology of childhood Type 1 diabetes in Taiwan, 2003 to 2008

Diabetic Medicine, 2014, 31(6), 666-673. DOI: 10.1111/dme.12407

Plateau of adiposity in Australian children diagnosed with Type 1 diabetes: a 20-year study

Diabetic Medicine, 2014, 31(6), 686-690. DOI: 10.1111/dme.12402

Use of clinical targets in diabetes patient education: qualitative analysis of the expectations and impact of a structured self-management programme in Type 1 diabetes

Diabetic Medicine, 2014, 31(6), 733-738. DOI: 10.1111/dme.12401

Substantial reductions in the number of diabetic ketoacidosis and severe hypoglycaemia episodes requiring emergency treatment lead to reduced costs after structured education in adults with Type 1 diabetes

Diabetic Medicine, 2014, 31(7), 847-853. DOI: 10.1111/dme.12441

Effects of advanced carbohydrate counting in patients with Type 1 diabetes: a systematic review

Diabetic Medicine, 2014, 31(8), 886-896. DOI: 10.1111/dme.12446

Reductions in resistance exercise-induced hyperglycaemic episodes are associated with circulating interleukin-6 in Type 1 diabetes

Diabetic Medicine, 2014, 31(8), 1009-1013. DOI: 10.1111/dme.12462