Significant reduction of ketoacidosis at diabetes onset in children and adolescents with type 1 diabetes—The Stuttgart Diabetes Awareness Campaign, Germany

Abstract

Background: To prevent the potentially life-threatening complication, diabetic ketoacidosis (DKA) at type 1 diabetes onset in children and adolescents, awareness campaigns can lead to a significant reduction of DKA. As in Germany, the incidence of DKA at diabetes onset had remained at a constant rate over the last 15 years and increasing numbers of very young children present with higher risk for DKA we decided to set up the Stuttgart Ketoacidosis Awareness Campaign. Methods: Over 3 years (2015-2017) the campaign was conducted using information flyers and posters illustrating the typical symptoms of diabetes at school entry health examinations at the Public Health Department, in day-care facilities, in all pediatric practices and by regular public activities. The period between 2011 and 2013 was selected as a reference period. Results: Approximately 17 000 children, median age 4.5 years, and their families were informed about the campaign during the preschool health examination. A total of 118 children and adolescents were treated with newly diagnosed type 1 diabetes compared with 127 during the reference period. During the campaign the incidence of DKA decreased significantly from 28% to 16%. Conclusions: Awareness campaigns like the Stuttgart Ketoacidosis Awareness Campaign about the typical clinical symptoms of type 1 diabetes can significantly reduce the risk for DKA at diabetes onset. Important factors for the success of our campaign were the close cooperation between the children's hospital and the public health department, the targeted approach of families, teachers, and pediatricians and the duration of the campaign over 3 years.

10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

“…For instance, the ‘Parma campaign’ (Italy), which delivered posters promoting the link between enuresis, polyuria, vomiting, abdominal pain, and diabetes to schools, parents, and pediatric practices, was associated with a marked reduction in DKA incidence at diagnosis (from 78% to 12.5% over two years) ( 39 ). Recently, the Stuttgart Ketoacidosis Awareness Campaign (Germany) also focused on the typical clinical symptoms of T1D and reduced the incidence of DKA (from 28% to 16% over three years) ( 35 ). However, not all awareness campaigns have been successful in reducing DKA rates at T1D diagnosis, achieving limited or no impact ( 34 , 36 ).…”

“…To this regard, community educational campaigns to prevent DKA have been proposed as a way of increasing awareness about T1D symptoms and related acute complications, in both parents/ caregivers and health care practitioners (34)(35)(36)(37)(38)(39). For instance, the 'Parma campaign' (Italy), which delivered posters promoting the link between enuresis, polyuria, vomiting, abdominal pain, and diabetes to schools, parents, and pediatric practices, was associated with a marked reduction in DKA incidence at diagnosis (from 78% to 12.5% over two years) (39).…”

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

“…ISPAD/the Life for a Child Program (LFAC) emphasis on increasing awareness not only of general population with posters in schools and markets has been successful in LFAC sites around the world in many low and medium resource countries but also in high resource countries like Italy and Canada for same reasons. Focused availability of ongoing pediatric and adolescent DKA lectures to emergency room and pediatricians and general practitioners helps in addition to the poster campaigns ( 24 ).…”

Kann die Ketoacidose bei pädiatrischen Patienten mit Manifestation eines Diabetes mellitus Typ 1 vermieden werden? Lehren aus der COVID-19-Pandemie

“…Am erfolgreichsten sind jene, die mehrere Komponenten integrieren [9]. So konnten in Stuttgart im Rahmen einer 3-jährigen Kampagne die Gesundheitsämter, Kinderarztpraxen, Kindergärten, Kindertagestätten und die Öffentlichkeit mit Flyern und Postern einbezogen hatte, die DKA-Rate bei Kindern unter 6 Jahren signifikant von 28 % auf 16 % reduziert werden, nicht aber die Rate schwerer DKA [12] [23]. Zusammenfassend könnte der Anstieg der Häufigkeit der DKA bei Diabetesmanifestation im Zusammenhang mit den gesamtgesellschaftlichen Veränderungen im Rahmen der Infektionsschutzmaßnahmen während der ersten Welle der "COVID-19-Pandemie" stehen.…”