Geographical variation of presentation at diagnosis of Type I diabetes in children: the EURODIAB Study

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 ag e 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 ye ars of age, recruited 1260 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 les s 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 ketoacido sis status, the overall proportion with diabetic ketoacidosis (pH < 7.3) wa s 40% (95%-CI: 36-44%) in at least 90% of cases. After stratification by ce ntre, 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 signific ant variation between the 11 centres in the frequency of diabetic ketoacido sis which ranged from 26 to 67% (p = 0.002). An inverse correlation between the frequency of diabetic ketoacidosis and the background incidence rate w as found in these centres (Spearman's rank correlation, r(s) = -0.715; p = 0.012). Conclusion/interpretation. Rising standards of medical information and grea ter awareness concurrent with an overall increase in incidence could have r esulted in changes in the clinical presentation at onset of Type I childhoo d diabetes in Europe.