Publications

Context: Approximately 19,000 children in the UK develop Type 1 DM (T1DM) each year. Unfortunately, up to 70% of newly diagnosed children present in diabetic ketoacidosis (DKA). This carries a significant risk of immediate life-threatening complications and also influences the longer-term clinical course of this disease. Understanding why some children present in DKA is important to enable primary care clinicians to plan interventions to reduce this excess morbidity and mortality.

Objective: To systematically review the factors associated with the presence of DKA at the time of diagnosis of T1DM in children.

Design: We searched PubMed, EMBASE, Web of Science, Scopus and Cinahl to identify primary research studies of children presenting with new onset T1DM which distinguished between children presenting with and without DKA.

Results: 44 studies involving over 17,000 children from 30 different countries were included in the final systematic review. There is a small increased risk of DKA when diagnosis is missed or delayed by doctors (OR 1.33 [1.06-1.68]) but the mean duration of symptoms did not differ between children presenting with or without DKA (16.5±6.2 and 17.1±6.0 days respectively), and there was no difference in the number of visits to primary care. DKA was associated with younger age, being of an ethnic minority group, low parental education, lower social status, lack of medical insurance, and low background T1DM incidence.

Conclusions: This is the first synthesis of factors associated with DKA in children with new onset T1DM. It identifies those children at greatest risk and the contribution of individual, family, physician and disease factors to that risk. The duration of symptoms before diagnosis and relatively small additional risk associated with physician factors suggests that future interventions should be targeted at families to help them recognise the early signs of T1DM and seek medical attention before progression to DKA.