Geographical variation of presentation at diagnosis of Type I diabetes in children: the EURODIAB Study
Open accessAbstract
Aims/hypothesis We aimed to describe the frequency and degree of diabetic ketoacidosis in children across Europe at the time of diagnosis of Type I (insulin-dependent) diabetes mellitus and to determine if factors such as age and geographical region contribute to the risk of diabetic ketoacidosis.Methods The study was part of the EURODIAB project. A total of 24 centres, covering a population at risk of more than 15 million children below 15 years of age, recruited 1,260 children at the time of clinical diagnosis.Results Polyuria, by far the most frequent symptom, was observed in 96% of the children. In only 25% of the children was the duration of symptoms less than 2 weeks and this proportion was larger in the under 5 year age-group (37 vs 22%; p < 0. 001). Of the 11 centres that recorded diabetic ketoacidosis status, the overall proportion with diabetic ketoacidosis (pH < 7.3) was 40% (95%-CI: 36-44%) in at least 90 % of cases. After stratification by centre, the odds ratio for diabetic ketoacidosis in the under 5 age-group was 1.02 (95%-CI:0.69-1.49) relative to the older children. There was significant variation between the 11 centres in the frequency of diabetic ketoacidosis which ranged from 26 to 67% (p = 0.002). An inverse correlation between the frequency of diabetic ketoacidosis and the background incidence rate was found in these centres (Spearman's rank correlation, rs = -0.715;p = 0.012).Conclusion/interpretation Rising standards of medical information and greater awareness concurrent with an overall increase in incidence could have resulted in changes in the clinical presentation at onset of Type I childhood diabetes in Europe.
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According to large epidemiologic studies, the incidence of type 1 diabetes has been rising by 2-5% worldwide.
“Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2–5% worldwide”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [12]
A strong inverse correlation was reported between the background rate of type 1 diabetes and the proportion of newly diagnosed youth presenting with diabetic ketoacidosis, such that centers with more type 1 diabetes children were more likely to diagnose them before this metabolic emergency.
“A strong inverse correlation between the background rate of T1D and proportion of newly diagnosed youth presenting with DKA was reported such that in centers with more T1D children were more likely to be diagnosed with T1D prior to the development of this metabolic emergency.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [12]
EURODIAB reported that polyuria was the most common presenting symptom (96%), followed by weight loss (61%) and fatigue (52%) in children at type 1 diabetes diagnosis.
“Polyuria was the most common presenting symptom (96%), followed by weight loss (61%) and fatigue (52%).”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [12]
Diabetic ketoacidosis, defined as pH<7.3, was reported in 42% of children at type 1 diabetes presentation, with 33% having pH between 7.3 and 7.1 and 9% having severe DKA (pH<7.1).
“DKA, defined as pH<7.3, was reported in 42% of children, with 33% having pH between 7.3 and 7.1 and 9% with severe DKA (<7.1).”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [12]
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“85,86 Although the frequency of admission with DKA is around 15% – 20% in countries such as Sweden and Canada, it reaches up to 70% in African countries.”
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Measured degree of dehydration in children and adolescents with type 1 diabetic ketoacidosis*
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Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients
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Management of Hyperglycemia and Diabetes in the Emergency Department
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Diabetes and blood glucose disorders under anti-PD1
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Postmortem diagnosis of unsuspected diabetes mellitus
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“[369] Levy-Marchal C, Patterson CC, Green A.”
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Clinical presentation of childhood type 1 diabetes mellitus in the Al-Madina region of Saudi Arabia
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Diabetic ketoacidosis: an overlooked child killer in sub‐ S aharan A frica?
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“The frequency of DKA relative to newly diagnosed diabetes globally varies regionally from 11% to 67% in Europe (L evy-Marchal et al. 2001) to 28.4% in the USA (Rosenbloom 2010a,b).”
BackgroundInfluentialVicinanza, A., Messaaoui, A., Tenoutasse, S., & Dorchy, H. (2019) · Pediatric Diabetes · doi:10.1111/pedi.12864 · Cited by 34 · see citing works
“Increasing medical information and awareness might have resulted in changes in the clinical presentation of T1D in developed countries.(3,7,8) Previous studies have shown different risk factors that might increase the likelihood of presenting with DKA.”
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Seasonal variation in the diagnosis of type 1 diabetes in south-east Sweden
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“There is also a trend that the clinical presentation has became less severe, especially ketoacidosis has became less common [38–40].”
BackgroundEpidemiologic Features of Type 1 Diabetic Patients between 0 and 18 Years of Age in İstanbul City
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The pathway to diagnosis of type 1 diabetes in children: a questionnaire study
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Beta-cell Specific Autoantibodies: Are they Just an Indicator of Type 1 Diabetes?
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“The incidence of T1D has considerably increased worldwide and significant effort is placed for its prediction, prevention and cure [2, 3].”
BackgroundNegrato, C. A., Cobas, R. A., Gomes, M. B., & on behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG) (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03590.x · Cited by 32 · see citing works
Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes
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Blood ketone bodies in patients with recent-onset type 1 diabetes (a multicenter study)
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Subcutaneous regular insulin for the treatment of diabetic ketoacidosis in children
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Self-citationEmergency Medicine Myths: Cerebral Edema in Pediatric Diabetic Ketoacidosis and Intravenous Fluids
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Diabetic Ketoacidosis in the Pediatric Emergency Department
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Type 1 diabetes mellitus in childhood
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Genetic polymorphisms in susceptibility to Type 1 Diabetes
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Current Concepts and Controversies in Prevention and Treatment of Diabetic Ketoacidosis in Children
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- Authors
- Lévy-Marchal, C., Patterson, C. C., Green, A., & on behalf of the EURODIAB ACE Study Group
- Affiliations
- Queen's University Belfast (GB)
- Aarhus University (DK)
- Venue
- Diabetologia
- Published
- 2001-10
- Volume
- 44
- Issue
- S3
- Pages
- B75-B80
- ISSN
- 0012-186X (ISSN-L)
- OpenAlex
- W2107493632
- Cited by
- 254
- References
- 17
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 14 · 2021: 6 · 2020: 11 · 2019: 11 · 2018: 12 · 2017: 13 · 2016: 13 · 2015: 18 · 2014: 17 · 2013: 18 · 2012: 13
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Open Repository and Bibliography (University of Luxembourg) (submittedVersion, cc-by-nc-sa)
- Research Portal (Queen's University Belfast) (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- type 1 diabetes, pediatric diabetes, diabetic ketoacidosis, regional variation, polyuria, symptom duration, age of onset, diabetes incidence
- MeSH terms
- Age Factors, Child, Child, Preschool, Diabetes Mellitus, Type 1, Europe, Geography, Humans, Infant, Polyuria, Incidence, Odds Ratio, Diabetic Ketoacidosis, Risk Assessment
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