Objectives: Diabetic ketoacidosis (DKA) is the leading cause of mortality in a type 1 diabetic mellitus (T1DM) in pediatric population. The prevalence of the DKA in the developed world ranges from 15% to 61% and in Croatia it is 33 to 36%. In the past few decades in Europe there have been no significant changes in the prevalence of DKA in patients with newly T1DM. In the previous preventive program known as the "Parma campaign", which was conducted between 1991 and 1998 and reduced the prevalence of DKA from the initial 78% to the cumulative prevalence during the campaign of 12.5%. The aim of the prevention program was to reduce the prevalence of DKA in the Southern part of Croatia in children and adolescents with newly diagnosed T1DM.
Methods: Prevention program was started in April 2017 and consists of a series of activities (lectures, TV shows, social networking, public posters, free phone line) aimed to educate the entire public, primarily children and adolescents, parents, employees in pre-school and school facilities and medical workers. The study included 37 children and adolescents with newly diagnosed T1DM during the prevention program period from 1 April 2017 to 31 December 2018 and control group of 54 children and adolescents with newly diagnosed T1DM before prevention program from 1 January 2015 to 31 March 2017. DKA was defined according to ISPAD guidelines from 2018.
Results: The prevalence of DKA in the pre-campaign period was 33.33% while in the period during the campaign was 24.3%. There was no significant difference in age (8.82 ± 4.82 vs. 9.48 ± 4.25 years, P = 0.504) and gender (31 (57.4%) male and 23 (42.6%) female vs. 27 (73%) male vs. 10 (27%) female, P = 0.129) between before and during prevention program. Fasting glucose significantly lower during the prevention program (29.28 ± 10.7 vs. 24.9 ± 9.59 mmol/L, P < 0.05), while fasting c-peptide was significantly higher during the prevention program (0.23 ± 0.16 vs. 0.35 ± 0.31 nmol/L, P < 0.05).
Conclusion: In conclusion, this study demonstrated a positive trend in reduction of DKA in children and adolescents with newly diagnosed T1DM during the preventive campaign. However, additional studies with long term follow-up are needed to further clarify the impact of public health prevention program on prevalence of DKA.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology