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First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study


Data regarding incidence of type 1 diabetes (T1DM), as well as data on frequency and severity of diabetic ketoacidosis (DKA) at the time of T1DM diagnosis is of paramount importance for national and regional healthcare planning. The aim of present multicenter study was to provide the first report regarding nationwide annual incidence rates for T1DM in youth in Serbia, as well as prevalence of DKA at the time of diagnosis. Data on all pediatric patients with newly diagnosed T1DM was retrospectively collected from all 15 regional centers for pediatric diabetes in Serbia during the period 2007–2017. During the study period, average-standardized incidence of T1DM in youth < 19 years was 11.82/100,000, and 14.28/100,000 in 0–14 years age group, with an average yearly increase in incidence of 5.9%. High prevalence of DKA (35.1%) at the time of diagnosis was observed, with highest frequency in children aged < 5 years (47.2%).

Conclusion: This is the first study reporting the nationwide incidence of T1DM and alarmingly high prevalence of DKA at diagnosis in youth in Serbia. The focus of public health preventive measures should be directed towards the preschoolers, considering the highest frequency and severity of DKA observed in this age group.

What is Known:
Knowing regional T1DM incidence is of paramount importance for resource allocation and healthcare services provision.
DKA is the leading cause of acute mortality in youth with T1DM, and public health preventive educational measures could improve early diagnosis and reduce the frequency and severity of DKA at presentation.
What is New:
Incidence of pediatric T1DM in Serbia is on the rise, with an average yearly increase of 5.9%.
Worryingly high prevalence of DKA (35.1%) at the time of T1DM diagnosis was observed, with the highest frequency of DKA in children aged < 5 years (47.2%).

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Fig. 1
Fig. 2



Diabetic ketoacidosis


Glycated hemoglobin A1c


International Society for Pediatric and Adolescent Diabetes


Standard deviation


Type 1 diabetes mellitus


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We gratefully acknowledge the kind help of pediatric endocrinology specialists from regional centers for pediatric diabetes in collecting all the necessary data for the nationwide database: Todorovic S, Mitrovic K, Zdravkovic V, Tucakovic T, Ljubojevic M, Lesovic S, Ilic T, Vrebalov M, Mikic M, Jelenkovic B, Petrovic R, Saric S, Cukanovic M, Simic D, Kanacki S.


No funding was received for the present study.

Author information

Rade Vukovic designed the research study, gathered the data from respective center, analyzed and integrated data from all centers, conducted statistical analyses and wrote the first draft of the manuscript. Maja D Jesic, Ivana Vorgucin, Sandra Stankovic, and Nevena Folic gathered the data from respective centers, contributed to study design and revised the manuscript. Tatjana Milenkovic, Silvija Sajic, Dragan Katanic, Sasa Zivic, and Slavica Markovic contributed to study design and revised the manuscript. Ivan Soldatovic conducted statistical analyses, contributed to study design and revised the manuscript. All authors reviewed and approved final version of the manuscript.

Correspondence to Rade Vukovic.

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The authors declare that they have no conflict of interest.

Informed consent

Informed consents were obtained from the parents or guardians of all participants for admission to hospitals and the procedures performed during the course of hospitalization. Study was approved by the Hospital Ethics Committee and data were retrospectively collected in accordance with the 1964 Declaration of Helsinki and its later amendments, and waiver was approved for individual written consent on the basis of non-identifiable use of previously obtained retrospectively collected data.

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Communicated by Peter de Winter

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Vukovic, R., Jesic, M.D., Vorgucin, I. et al. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study. Eur J Pediatr 177, 1155–1162 (2018). https://doi.org/10.1007/s00431-018-3172-4

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  • Type 1 diabetes mellitus
  • Diabetic ketoacidosis
  • Incidence
  • Prevalence
  • Children
  • Serbia