Ketoacidosis at diagnosis of type 1 diabetes

in children and adolescents:

role of the general practitioners
Anne-Marie Bertrand1, Karine Chabot1, Julie Blanchard2,
Corinne Colmel3, Fatiha Guemazi4, Chantal Metz2, Claire Le Tallec3,
Patrick Lartiguet3, Carine Choleau5, Jean-Jacques Robert5
Endocrinologie-diabtologie pdiatriques, CHU Jean Minjoz, Besanon
2 Service de Pdiatrie, CHU de Brest
3 Enfance/Adolescence Diabte Midi-Pyrnes, Toulouse
4 Service de Pdiatrie, Hpital du Hasenrain, Mulhouse
5 LAide aux Jeunes Diabtiques, Paris
1

We declare no conflict of interest

Survey Diabte Enfant et Adolescent

146 paediatric centers in 21/22 regions
63% of all centers
33-83% depending on regions

Precampaign: november 14th 2009 november 13th 2010

DKA at diagnosis (n = 1299)
pH < 7.30

80

% des patients

pH < 7.10

60

40

20

0
0-5 ans

5-10 ans

10-15 ans

DKA

54.2%

43.4%

37.2%

Severe DKA

16.6%

14.4%

13.9%

Campaign Diabte Enfant et Adolescent

De lhyperglycmie
lacidoctose

Change in DKA over 3 years of campaign

Relative decrease:
20%*
8%*
50

Relative decrease:

50

43,9%
40,5%
40

40

28%*

35,1%
30

30

20

20

23%*
14,8%

10

10

Anne 1

Anne 2

DKA

Anne 3

Anne 1

11,4%

10,6%

Anne 2

Anne 3

Severe DKA
* p< 0,05

Regional interventions for the prevention of DKA

at diagnosis of type 1 diabetes
In Franche-Comt and Midi-Pyrnes
Paediatricians

Maternal and Child Welfare

France
Comt
80

General practitioners
Pharmacists
Schools
General population:
press, radio
posters in public places (3 weeks)

Midi-Pyrnes
60

Regional interventions for the prevention of DKA

at diagnosis of type 1 diabetes

Before

After

In Franche-Comt:
DKA
Severe DKA

61%
25%

36%
9%

In Midi-Pyrnes:
DKA
Severe DKA

46%
20%

40%
3%

Who refered the young people to the hospital?

% of admissions

60
50
40
30
20
10
0
Generalist

Pediatrician

Family

Questionnaire for general practitioners

on diagnosis of diabetes in childhood

325 general practictioners

Alsace, Bretagne, Franche-Comt

Sex (% Men)
Age

< 40 yr
40-50 yr
50-60 yr
> 60 yr

59%
24%
23%
36%
16%

Bretagne
77,78
France
Comt
80

Questionnaire for general practitioners

on diagnosis of diabetes in childhood
On which signs do you make the diagnosis ?
Polyuria polydipsia

96%

Abdominal pain

47%

Loss of weight

93%

Urinary infection

44%

Asthenia

85%

Enuresia

34%

Dehydration

59%

Anomalies of vision

21%

Family history

52%

Dyspnea

13%

Vomiting

49%

Obesity

12%

Questionnaire for general practitioners

on diagnosis of diabetes in childhood

Tests

Blood

Is necessary
Is not enough

90%

Fasting

88%

> 126 mg/dl twice

63%

Urine
29%

Questionnaire for general practitioners

on diagnosis of diabetes in childhood

You refer the child to

Emergency unit
Consultation
Paediatrics
Endocrinology

77%

Immediately
The next morning
Within a week (or +)

71%
21%
7%

18%
10%

Questionnaire for general practitioners

on diagnosis of diabetes in childhood

DKA may be fatal

89%

Diabetes exists before 5 yr of age

Diabetes exists before 2 yr of age

94%
63%

You would start the treatment

By yourself
With diet alone

30%
47%

Questionnaire for general practitioners

on diagnosis of diabetes in childhood

General practitioners seemed concerned about their

important role in the diagnosis of childhood diabetes:
they were responsive to the regional campaigns
They had little recent information on childhood diabetes
They did not know the specificities of childhood diabetes:
practices relevant to adult type 2 diabetes

Conclusions
Which strategy for a prevention campaign ?
The campaign must be long term:
simple and cost-effective

General practitioners are major targets:

the poster may not be the best tool
The Parma model is to be adapted to the context