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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

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Abstract

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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Abbreviations

DKA:

Diabetic ketoacidosis

HbA1c:

Glycated hemoglobin A1c

ISPAD:

International Society for Pediatric and Adolescent Diabetes

SD:

Standard deviation

T1DM:

Type 1 diabetes mellitus

References

  1. Abdul-Rasoul M, Al-Mahdi M, Al-Qattan H, Al-Tarkait N, Alkhouly M, Al-Safi R, Al-Shawaf F, Mahmoud H (2010) Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics. Pediatr Diabetes 11:351–356

    Article  PubMed  CAS  Google Scholar 

  2. Bui H, To T, Stein R, Fung K, Daneman D (2010) Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr 156:472–477

    Article  PubMed  Google Scholar 

  3. Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC (2014) Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 15(Suppl 20):4–17

    Article  PubMed  CAS  Google Scholar 

  4. Dabelea D, Bell RA, D’Agostino RB Jr, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B (2007) Incidence of diabetes in youth in the United States. JAMA 297:2716–2724

    Article  PubMed  Google Scholar 

  5. Edge JA, Ford-Adams ME, Dunger DB (1999) Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child 81:318–323

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Edge JA, Jakes RW, Roy Y, Hawkins M, Winter D, Ford-Adams ME, Murphy NP, Bergomi A, Widmer B, Dunger DB (2006) The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children. Diabetologia 49:2002–2009

    Article  PubMed  CAS  Google Scholar 

  7. Ehtisham S, Hattersley AT, Dunger DB, Barrett TG (2004) First UK survey of paediatric type 2 diabetes and MODY. Arch Dis Child 89:526–529

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. EURODIAB_ACE_Study_Group (2000) Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group. Lancet 355:873–876

    Article  Google Scholar 

  9. Jesic MD, Jesic MM, Stanisavljevic D, Zdravkovic V, Bojic V, Vranjes M, Trifunovic D, Necic S, Sajic S (2013) Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia. Eur J Pediatr 172:1581–1585

    Article  PubMed  CAS  Google Scholar 

  10. Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J (2000) Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 23:1516–1526

  11. Kleinberger JW, Pollin TI (2015) Undiagnosed MODY: time for action. Curr Diab Rep 15:110

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Levy-Marchal C, Patterson CC, Green A (2001) Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and Dibetes. Diabetologia 44(Suppl 3):B75–B80

    Article  PubMed  Google Scholar 

  13. Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ (2010) Epidemiology of type 1 diabetes. Endocrinol Metab Clin N Am 39:481–497

    Article  Google Scholar 

  14. Neu A, Willasch A, Ehehalt S, Hub R, Ranke MB, Baden-Wuerttemberg DG (2003) Ketoacidosis at onset of type 1 diabetes mellitus in children—frequency and clinical presentation. Pediatr Diabetes 4:77–81

    Article  PubMed  Google Scholar 

  15. Patterson CC, Gyurus E, Rosenbauer J, Cinek O, Neu A, Schober E, Parslow RC, Joner G, Svensson J, Castell C, Bingley PJ, Schoenle E, Jarosz-Chobot P, Urbonaite B, Rothe U, Krzisnik C, Ionescu-Tirgoviste C, Weets I, Kocova M, Stipancic G, Samardzic M, de Beaufort CE, Green A, Dahlquist GG, Soltesz G (2012) Trends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of non-uniformity over time in rates of increase. Diabetologia 55:2142–2147

    Article  PubMed  CAS  Google Scholar 

  16. Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M (2014) Diabetes in the young—a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 103:161–175

    Article  PubMed  Google Scholar 

  17. Quinn M, Fleischman A, Rosner B, Nigrin DJ, Wolfsdorf JI (2006) Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr 148:366–371

    Article  PubMed  Google Scholar 

  18. Roche EF, McKenna AM, Ryder KJ, Brennan AA, O'Regan M, Hoey HM (2016) Is the incidence of type 1 diabetes in children and adolescents stabilising? The first 6 years of a National Register. Eur J Pediatr 175:1913–1919

    Article  PubMed  Google Scholar 

  19. Segi M (1960) Cancer mortality for selected sites in 24 countries (1950-1957). Tohuku University School of Medicine, Sendai

    Google Scholar 

  20. Sipetic S, Maksimovic J, Vlajinac H, Ratkov I, Sajic S, Zdravkovic D, Sipetic T (2013) Rising incidence of type 1 diabetes in Belgrade children aged 0-14 years in the period from 1982 to 2005. J Endocrinol Investig 36:307–312

    CAS  Google Scholar 

  21. Sperling MA (2005) Diabetic ketoacidosis in children: the problems continue. Pediatr Diabetes 6:67–68

    Article  PubMed  Google Scholar 

  22. Szypowska A, Skorka A (2011) The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes 12:302–306

    Article  PubMed  Google Scholar 

  23. The_DIAMOND_Project_Group (2006) Incidence and trends of childhood type 1 diabetes worldwide 1990-1999. Diabet Med 23:857–866

    Article  Google Scholar 

  24. Vlajinac HD, Bojovic BM, Sipetic SB, Adanja BJ, Jarebinski MS, Radmanovic SZ, Zdravkovic DS (1995) Insulin dependent diabetes mellitus: incidence in childhood in Belgrade 1982-92. J Epidemiol Community Health 49:107–108

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Vukovic R, Mitrovic K, Milenkovic T, Todorovic S, Zdravkovic D (2012) Type 2 diabetes mellitus and impaired glucose regulation in overweight and obese children and adolescents living in Serbia. Int J Obes 36:1479–1481

    Article  CAS  Google Scholar 

  26. Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V, Lee WW, Mungai LN, Rosenbloom AL, Sperling MA, Hanas R (2014) ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 15(Suppl 20):154–179

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

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.

Funding

No funding was received for the present study.

Author information

Authors and Affiliations

  1. Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”, Radoja Dakica 8, Belgrade, 11070, Serbia

    Rade Vukovic & Tatjana Milenkovic

  2. University Children’s Hospital, Tirsova 10, Belgrade, 11000, Serbia

    Maja D. Jesic & Silvija Sajic

  3. School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, 11000, Serbia

    Maja D. Jesic & Silvija Sajic

  4. Institute for Children and Youth Health Care of Vojvodina, Hajduk Veljkova 10, Novi Sad, 21000, Serbia

    Ivana Vorgucin & Dragan Katanic

  5. Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia

    Ivana Vorgucin & Dragan Katanic

  6. Children Clinic, Clinical Center Nis, Dr Zorana Djindjica Blvd. 48a, Nis, 18000, Serbia

    Sandra Stankovic & Sasa Zivic

  7. Pediatric Clinic, Clinical Centre Kragujevac, Zmaj Jovina 30, Kragujevac, 34000, Serbia

    Nevena Folic & Slavica Markovic

  8. Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, Kragujevac, 34000, Serbia

    Nevena Folic & Slavica Markovic

  9. Faculty of Medicine, University of Nis, Dr Zorana Djindjica Blvd. 81, Nis, 18000, Serbia

    Sasa Zivic

  10. Institute for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, 11000, Serbia

    Ivan Soldatovic

Authors
  1. Rade Vukovic
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  2. Maja D. Jesic
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  3. Ivana Vorgucin
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  4. Sandra Stankovic
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  5. Nevena Folic
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  6. Tatjana Milenkovic
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  7. Silvija Sajic
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  8. Dragan Katanic
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  9. Sasa Zivic
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  10. Slavica Markovic
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  11. Ivan Soldatovic
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Contributions

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.

Corresponding author

Correspondence to Rade Vukovic.

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Conflict of interest

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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  • DOI: https://doi.org/10.1007/s00431-018-3172-4

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