Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. "The Parma campaign"

Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. "The Parma campaign".

Vanelli M, Scarabello C, Fainardi V.

Interuniversity and Regional Centre for Diabetes Care and Research in Children and Adolescents, Post-graduate School of Paediatrics, University of Parma, Parma, Italy. maurizio.vanelli@unipr.it

Diabetic Ketoacidosis (DKA) is a leading cause of death and disability in children with type 1 diabetes (T1D) and it is generally related to a long duration of misdiagnosed hyperglycaemia-related symptoms. Shortening this latency period could be a winning preventive strategy. It is intuitively easy to achieve this goal when other members with T1D in a family exist, as well as during the follow-up of the relatives of patients with T1D positive for genetic, immunological or metabolic markers. An incidental blood glucose level over 100 mg/dl found in children without history for T1D has been reported as indicative of a progressive beta-cell dysfunction and so it may be recommended for DKA prevention at diabetes diagnosis. More encouraging results have been obtained with a campaign of information promoted in schools and in paediatricians' offices, centred on the earliest symptom of diabetes (nocturnal enuresis in a dry child) as reported by 89% of parents. During 8 years of this campaign, the cumulative frequency of DKA dropped from 78% to 12.5% and its long effects were still observed several years after it was promoted. The Parma campaign obtained a reduction in DKA incidence at diabetes diagnosis never found before. The key-success of this campaign may be attributed to the communication of a valuable and reliable message easy to understand and follow; information toward a large population through school and paediatric consultation; involvement of family paediatricians and Parents' Association; free access to experienced health providers in diabetes diagnosis.

PMID: 18551826 [PubMed - indexed for MEDLINE]