{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:33:18Z","timestamp":1785803598974,"version":"3.56.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic ketoacidosis (DKA) is a morbid complication of Type 1 diabetes mellitus(T1DM), and its occurrence at diagnosis has rarely been studied in Ethiopia, despite the many cases seen in the pediatric population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to know the prevalence of DKA among patients with newly diagnosed diabetes mellitus and identify avoidable risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This institution-based retrospective cross-sectional study was conducted from December 1, 2018 to December1, 2022. Newly diagnosed T1DM under 15 years were included in the study. DKA and the new diagnosis of type 1 DM were defined based on the 2022 ISPAD and other international guidelines. A data collection form was used to collect sociodemographic and clinical data. Descriptive, bivariate, and multivariate logistic regression analyses were conducted to identify the risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among the 61 newly diagnosed T1DM pediatric patients admitted, DKA was the initial presentation in 37 patients, accounting for 60.7% of the cases. The mean age at diagnosis was 8 (\u00b13.85) years, with females being more affected. Clinical presentation revealed vomiting accompanied by signs of dehydration (32.4%), with polyuria, polydipsia and weight loss (26.2%) being the most common symptoms. The presence of adequate knowledge of signs and symptoms of DM (AOR = 0.07, 95%CI 0.019\u20130.0897, P value 0.017) and a family history of DM (AOR = 0.129 95%CI 0.019\u20130.897, P value 0.039) were protective factors against DKA as the initial diagnosis of DM. Moreover, new-onset type 1 DM without DKA was 1.5 times higher in children from families with a high monthly income (AOR = 1.473, 95% CI 0.679\u20133.195 p value 0.000) compared to those from families with low income. The presence of an infection prior to DKA (AOR = 11.69,95%CI 1.34\u201310.1,P value 0.026) was associated with the diagnosis of DKA at the initial presentation of DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A high number of children present with diabetic ketoacidosis (DKA) at the initial diagnosis of diabetes mellitus (DM), which is associated with inadequate knowledge of the signs and symptoms of DM as well as the masking effect of concomitant infections in these children. Healthcare professionals should endeavor to suspect and screen children. Continuous awareness creation of DM is encouraged to diagnose diabetes mellitus earlier and to decrease the prevalence of DKA as an initial presentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0314433","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T13:24:29Z","timestamp":1738243469000},"page":"e0314433","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: Prevalence and predictors"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5050-8337","authenticated-orcid":true,"given":"Dinberu Oyamo","family":"Oromo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"issue":"7","key":"pone.0314433.ref001","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022:Diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"N Glaser","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/srep10358","article-title":"15- year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting (Auckland, New Zealand)","volume":"5","author":"C Jefferies","year":"2015","journal-title":"Sci. Rep"},{"key":"pone.0314433.ref003","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1007\/s00125-012-2690-2","article-title":"Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review","volume":"55","author":"JA Usher Smith","year":"2012","journal-title":"Diabetologia"},{"key":"pone.0314433.ref004","unstructured":"Non-Communicable O. National strategic action plan (nsap) for prevention & control (of non-communicable diseases in Ethiopia. (2016), Google Scholar. Ministry of Health."},{"key":"pone.0314433.ref005","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1111\/tmi.12195","article-title":"Diabetic ketoacidosis an overlooked child killer in sub-Saharan Africa","volume":"18","author":"AN Murunga","year":"2013","journal-title":"Tropical Med Int Health"},{"key":"pone.0314433.ref006","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cupe.2005.12.010","article-title":"Diabetic Ketoacidosis","volume":"16","author":"CP Smith","year":"2006","journal-title":"Current Pediatrics"},{"key":"pone.0314433.ref007","first-page":"1","article-title":"Prevalence of diabetic ketoacidosis in newly diagnosed diabetes mellitus pediatric patients in TikurAnbessa Specialized Hospital","volume":"4","author":"B Fantahun","year":"2008","journal-title":"Off Organ Ethiopian Pediatr Soc"},{"key":"pone.0314433.ref008","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/PHMT.S207165","article-title":"Diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Tigray, Ethiopia: retrospective observational study","volume":"10","author":"FB Hadgu","year":"2019","journal-title":"Pediatric Health Med Ther"},{"key":"pone.0314433.ref009","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13052-020-00930-4","article-title":"Incidence and predictors of diabetic ketoacidosis among children with diabetes in west and east Gojjam zone referral hospitals, northern Ethiopia, 2019","volume":"46","author":"B Assefa","year":"2020","journal-title":"Ital J Pediatr"},{"key":"pone.0314433.ref010","doi-asserted-by":"crossref","first-page":"490","DOI":"10.4103\/mjdrdypu.mjdrdypu_227_18","article-title":"Retrospective review of presentation of newly diagnosed children with diabetes mellitus in a Nigerian rural setting","volume":"12","author":"UI Umar","year":"2019","journal-title":"Med J DY Patil Vidyapeeth"},{"key":"pone.0314433.ref011","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1111\/pedi.13064","article-title":"Significant reduction of ketoacidosis at diabetes onset in children and adolescents with type 1 diabetes\u2013The Stuttgart Diabetes Awareness Campaign, Germany","volume":"21","author":"M Holder","year":"2020","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref012","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4103\/0256-4947.81529","article-title":"Pattern of presentation in type 1 diabetic patients at the diabetes center of a university hospital","volume":"31","author":"A. Al Rashed","year":"2011","journal-title":"Ann Saudi Med"},{"key":"pone.0314433.ref013","first-page":"911","article-title":"Epidemiology of type I diabetes mellitus among Arab children","volume":"26","author":"MA Abdullah","year":"2019","journal-title":"Saudi Med J"},{"issue":"Suppl 1","key":"pone.0314433.ref014","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.4103\/2230-8210.155402","article-title":"Puberty and type 1 diabetes","volume":"19","author":"S. Chowdhury","year":"2015","journal-title":"Indian J Endocrinol Metab"},{"issue":"4","key":"pone.0314433.ref015","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5937\/ZZ1904007T","article-title":"High prevalence of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes in Belgrade, Serbia: 10-year tertiary centre experience","volume":"48","author":"S Todorovi\u0107","year":"2019","journal-title":"Zdravstvena za\u0161tita"},{"issue":"5","key":"pone.0314433.ref016","doi-asserted-by":"crossref","first-page":"286","DOI":"10.5603\/DK.2020.0042","article-title":"Clinical characterstics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes","volume":"9","author":"Noha Arafa","year":"2020","journal-title":"Clinical diabetology"},{"issue":"8","key":"pone.0314433.ref017","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1111\/pedi.13456","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022:Management of the child, adolescent, and young adult with diabetes in limited resource settings","volume":"23","author":"A Virmani","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref018","doi-asserted-by":"crossref","first-page":"e363","DOI":"10.1002\/edm2.363","article-title":"Outcome of diabetic ketoacidosis among paediatric patients managed with modified DKA protocol at Tikur Anbessa specialized hospital and Yekatit 12 hospital, Addis Ababa, Ethiopia","volume":"5","author":"T Bacha","year":"2022","journal-title":"Endocrinol Diab Metab"},{"key":"pone.0314433.ref019","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1542\/peds.2012-1049","article-title":"Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols","volume":"131","author":"NS Glaser","year":"2013","journal-title":"J Pediatr"},{"key":"pone.0314433.ref020","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1056\/NEJM197708042970502","article-title":"Diabetic ketoacidosis: low-dose insulin therapy by various routes","volume":"297","author":"MN Shahshahani","year":"1977","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0314433.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0169666","article-title":"Clinical characteristics of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes in Ethiopia. A cross-sectional study","volume":"12","author":"HS Atkilt","year":"2017","journal-title":"PLoS One"},{"key":"pone.0314433.ref022","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4103\/ajop.ajop_23_22","article-title":"Diabetic ketoacidosis among Egyptian children and adolescents in the coronavirus disease 2019 era: a single-center retrospective study","volume":"35","author":"K Ismail","year":"2022","journal-title":"Alexandria J Pediatr"},{"key":"pone.0314433.ref023","doi-asserted-by":"crossref","first-page":"926013","DOI":"10.3389\/fped.2022.926013","article-title":"Increased severe cases and new-onset type 1 diabetes among children presenting with diabetic ketoacidosis during first year of COVID-19 pandemic in Turkey","volume":"10","author":"E Kiral","year":"2022","journal-title":"Front Pediatr"},{"key":"pone.0314433.ref024","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1038\/s41390-022-02241-2","article-title":"Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes","volume":"93","author":"A Elgenidy","year":"2023","journal-title":"Pediatr Res"},{"key":"pone.0314433.ref025","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13098-024-01267-2","article-title":"Covid 19 and diabetes in children: advances and strategies","volume":"16","author":"Z Wu","year":"2024","journal-title":"Diabetol Metab Syndr"},{"issue":"2","key":"pone.0314433.ref026","doi-asserted-by":"crossref","first-page":"841","DOI":"10.4314\/ahs.v20i2.38","article-title":"Frequency and severity of ketoacidosis at diagnosis among childhood type 1 diabetes in Khartoum state, Sudan","volume":"20","author":"AM Ahmed","year":"2020","journal-title":"Afri Health Sci"},{"key":"pone.0314433.ref027","first-page":"126","article-title":"Clinical Presentation and Factors Associated with Diabetic Ketoacidosis at the Onset of Type-1 Diabetes Mellitus in Children and Adolescent at Muhimbili National Hospital, Tanzania:A cross sectional study","volume":"7","author":"H Kipasika","year":"2020","journal-title":"int J Diabetes Clin Res"},{"issue":"1","key":"pone.0314433.ref028","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/2251-6581-12-47","article-title":"Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics","volume":"12","author":"N. Onyiriuka","year":"2013","journal-title":"Journal of Diabetes and Metabolic Disorders"},{"issue":"5","key":"pone.0314433.ref029","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1136\/archdischild-2013-304818","article-title":"Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK","volume":"99","author":"K. Lokulo-Sodipe","year":"2014","journal-title":"Archives of Disease in Childhood"},{"key":"pone.0314433.ref030","first-page":"367","article-title":"Diabetic ketoacidosis at manifestation of type 1 diabetes in childhood and adolescence\u2014incidence and risk factors","volume":"118","author":"H Segerer","year":"2021","journal-title":"Dtsch Arztebl Int"},{"key":"pone.0314433.ref031","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.2337\/dc09-2344","article-title":"Veijola R; Finnish Pediatric Diabetes Register. Age related differences in the frequency of ketoacidosis at diagnosis of type 1 diabetes in children and adolescents","volume":"33","author":"A Hekkala","year":"2010","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref032","doi-asserted-by":"crossref","first-page":"653519","DOI":"10.3389\/fendo.2021.653519","article-title":"10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)","volume":"12","author":"W Peng","year":"2021","journal-title":"Front. Endocrinol"},{"issue":"8","key":"pone.0314433.ref033","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1007\/s00125-020-05152-1","article-title":"Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents","volume":"63","author":"V Cherubini","year":"2020","journal-title":"Diabetologia"},{"key":"pone.0314433.ref034","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1055\/s-0044-102090","article-title":"Incidence of diabetic ketoacidosis of new-onset type 1 diabetes in children and adolescents in different countries correlates with Human Development Index (HDI): an updated systematic review, meta-analysis, and meta-regression","volume":"50","author":"J Gro\u00dfe","year":"2018","journal-title":"Horm Metab Res"},{"issue":"3","key":"pone.0314433.ref035","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s00125-018-4763-3","article-title":"Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989\u20132013: a multicenter prospective registration study","volume":"62","author":"CC Patterson","year":"2019","journal-title":"Diabetologia"},{"key":"pone.0314433.ref036","doi-asserted-by":"crossref","first-page":"d4092","DOI":"10.1136\/bmj.d4092","article-title":"Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review","volume":"343","author":"JA Usher-Smith","year":"2011","journal-title":"BMJ"},{"key":"pone.0314433.ref037","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.2337\/dc15-0780","article-title":"Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the US, Austria, and Germany","volume":"38","author":"DM Maahs","year":"2015","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref038","first-page":"7","article-title":"Diabetic Ketoacidosis in an Addis Abeba Children\u2019s Hospital","volume":"30","author":"D. Teshome","year":"1992","journal-title":"Ethiop Med J"},{"issue":"Suppl 3","key":"pone.0314433.ref039","first-page":"B75","article-title":"Europe and Diabetes. Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and Dibetes","volume":"44","author":"EURODIAB ACE Study Group","year":"2001","journal-title":"Diabetologia"},{"key":"pone.0314433.ref040","doi-asserted-by":"crossref","first-page":"e2018204","DOI":"10.1590\/1984-0462\/2020\/38\/2018204","article-title":"DIABETIC KETOACIDOSIS AS THE INITIAL PRESENTATION OF TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS: EPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL","volume":"38","author":"LCVF Souza","year":"2019","journal-title":"Rev Paul Pediatr"},{"issue":"2","key":"pone.0314433.ref041","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/j.1399-543X.2005.00110.x","article-title":"Clinical presentation of type 1 diabetes","volume":"6","author":"EF Roche","year":"2005","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref042","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jpeds.2009.10.001","article-title":"Is diabetic ketoacidosis at disease onset a result of missed diagnosis?","volume":"156","author":"H Bui","year":"2010","journal-title":"J Pediatr"},{"issue":"6","key":"pone.0314433.ref043","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2337\/diacare.27.6.1399","article-title":"Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up","volume":"27","author":"DAISY study","year":"2004","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref044","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2337\/diacare.22.1.7","article-title":"Effectiveness of a prevention program for diabetic ketoacidosis in children","volume":"22","author":"M Vanelli","year":"1999","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref045","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.2337\/dc07-0059","article-title":"Campaign for diabetic ketoacidosis prevention still effective 8 years later","volume":"30","author":"M Vanelli","year":"2007","journal-title":"Diabetes Care"},{"issue":"5","key":"pone.0314433.ref046","doi-asserted-by":"crossref","first-page":"769","DOI":"10.2337\/dc08-1872","article-title":"Diabetic subjects diagnosed through the diabetes prevention trial type 1 (DPT-1) are often asymptomatic with normal A1C at diabetes onset","volume":"32","author":"the DPT-1 Study Group","year":"2009","journal-title":"Diabetes Care"},{"issue":"11","key":"pone.0314433.ref047","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.2337\/dc11-1026","article-title":"Reduced prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in young children participating in longitudinal follow-up","volume":"34","author":"TEDDY Study Group","year":"2011","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref048","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/archdischild-2019-316903","article-title":"Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0\u201318 years","volume":"105","author":"I Rabbone","year":"2020","journal-title":"Arch Dis Child"},{"key":"pone.0314433.ref049","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/j.1399-5448.2012.00896.x","article-title":"A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes","volume":"13","author":"BR King","year":"2012","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref050","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1111\/j.1464-5491.2012.03638.x","article-title":"Prevalence of ketoacidosis at diagnosis of childhood onset Type 1 diabetes in Wales from 1991 to 2009 and effect of publicity campaign","volume":"29","author":"AJ Lansdown","year":"2012","journal-title":"Diabetes Med"},{"issue":"7","key":"pone.0314433.ref051","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1111\/pedi.12722","article-title":"A brief campaign to prevent diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: the NO-DKA study","volume":"19","author":"JGB Derraik","year":"2018","journal-title":"Pediatr Diabetes"},{"key":"pone.0314433.ref052","doi-asserted-by":"crossref","first-page":"1484.e1","DOI":"10.1016\/j.jpeds.2013.06.033","article-title":"Diabetic ketoacidosis at diagnosis in Austrian children: a population-based analysis, 1989\u20132011","volume":"163","author":"M Fritsch","year":"2013","journal-title":"J Pediatr"},{"key":"pone.0314433.ref053","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1515\/JPEM.2002.15.8.1137","article-title":"Clinical characteristics and predictors of severe ketoacidosis at onset of type 1 diabetes mellitus in children in a North Rhine-Westphalian region, Germany","volume":"15","author":"J Rosenbauer","year":"2002","journal-title":"J Pediatr Endocrinol Metab"},{"key":"pone.0314433.ref054","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0168-8227(01)00328-X","article-title":"Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition","volume":"55","author":"V Sadauskaite-Kuehne","year":"2002","journal-title":"Diabetes Res Clin Pract"},{"key":"pone.0314433.ref055","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1136\/adc.75.5.410","article-title":"Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function","volume":"75","author":"J Komulainen","year":"1996","journal-title":"Arch Dis Childhood"},{"key":"pone.0314433.ref056","doi-asserted-by":"crossref","first-page":"e1258","DOI":"10.1542\/peds.2007-1105","article-title":"Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: The search for diabetes in youth study","volume":"121","author":"A Rewers","year":"2008","journal-title":"Pediatrics"},{"key":"pone.0314433.ref057","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.2337\/diacare.22.12.1950","article-title":"Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group","volume":"22","author":"J Komulainen","year":"1999","journal-title":"Diabetes Care"},{"key":"pone.0314433.ref058","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/j.1651-2227.1998.tb01499.x","article-title":"Ketoacidosis occurring in newly diagnosed and established diabetic children","volume":"87","author":"CP Smith","year":"1998","journal-title":"Acta Paediatrica"},{"key":"pone.0314433.ref059","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1136\/bmj.2.6029.211","article-title":"Mode of presentation of juvenile diabetes","volume":"2","author":"DV Hamilton","year":"1976","journal-title":"BMJ"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0330202","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T13:24:48Z","timestamp":1738243488000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314433"}},"subtitle":[],"editor":[{"given":"Elsayed","family":"Abdelkreem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,30]]},"references-count":59,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0314433","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.03.10.24303986","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,30]]}}}