{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:28:45Z","timestamp":1787678925484,"version":"build-2784847793"},"reference-count":81,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Timely recognition of type 1 diabetes (T1D) in children and adolescents is crucial to prevent acute complications such as diabetic ketoacidosis (DKA). This narrative review examines the pathophysiology, clinical presentation, and diagnostic challenges of childhood T1D, including the young age of onset, clinician training gaps, and overlapping symptomatology between T1D and other common pediatric illnesses. Despite increased awareness, a significant proportion of children still present with DKA at diagnosis due to misinterpretation of symptoms, such as polydipsia, polyuria, and weight loss. This work emphasizes the importance of early recognition, timely intervention, and the use of structured management algorithms for primary care clinicians. Strategies to reduce DKA incidence, based on existing literature, successful real-world examples, and current guidelines, include enhanced screening for high-risk populations, educational initiatives, and improved diagnostic protocols. By implementing systematic approaches and public health campaigns, healthcare providers can improve early T1D detection and prevent severe DKA complications, ultimately enhancing patient outcomes and reducing long-term morbidity.<\/jats:p>","DOI":"10.3390\/jcm15020533","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:09:06Z","timestamp":1767946146000},"page":"533","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Enhancing Primary Care Recognition of Type 1 Diabetes in Children: Diagnostic Challenges and Strategies to Prevent Diabetic Ketoacidosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3487-0664","authenticated-orcid":false,"given":"Yung-Yi","family":"Lan","sequence":"first","affiliation":[{"name":"Center for Medical Education in English, Poznan University of Medical Sciences, 41 Jackowskiego St., 60-512 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3314-7422","authenticated-orcid":false,"given":"Rujith","family":"Kovinthapillai","sequence":"additional","affiliation":[{"name":"Center for Medical Education in English, Poznan University of Medical Sciences, 41 Jackowskiego St., 60-512 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"K\u0119dzia","sequence":"additional","affiliation":[{"name":"Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, ul. Szpitalna 27\/33, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3245-8131","authenticated-orcid":false,"given":"El\u017cbieta","family":"Niechcia\u0142","sequence":"additional","affiliation":[{"name":"Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, ul. Szpitalna 27\/33, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2337\/diab.14.10.619","article-title":"Pathologic Anatomy of the Pancreas in Juvenile Diabetes Mellitus","volume":"14","author":"Gepts","year":"1965","journal-title":"Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1056\/NEJM198605223142106","article-title":"Type I Diabetes Mellitus","volume":"314","author":"Eisenbarth","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0140-6736(13)60591-7","article-title":"Type 1 Diabetes","volume":"383","author":"Atkinson","year":"2014","journal-title":"Lancet"},{"key":"ref_4","unstructured":"International Diabetes Federation (2025). IDF Diabetes Atlas, IDF. [11th ed.]. Available online: https:\/\/diabetesatlas.org."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S94","DOI":"10.2337\/diacare.27.2007.S94","article-title":"Hyperglycemic Crises in Diabetes","volume":"27","author":"Kitabchi","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/j.1464-5491.2011.03246.x","article-title":"Joint British Diabetes Societies Guideline for the Management of Diabetic Ketoacidosis","volume":"28","author":"Savage","year":"2011","journal-title":"Diabet. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5114\/ctd\/203685","article-title":"Standards of Care in Diabetes. The Position of Diabetes Poland\u20142025","volume":"5","author":"Araszkiewicz","year":"2025","journal-title":"Curr. Top. Diabetes"},{"key":"ref_8","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":"Glaser","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.2337\/dc09-9032","article-title":"Hyperglycemic Crises in Adult Patients with Diabetes","volume":"32","author":"Kitabchi","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1542\/peds.113.2.e133","article-title":"ESPE\/LWPES Consensus Statement on Diabetic Ketoacidosis in Children and Adolescents","volume":"113","author":"Dunger","year":"2004","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.2337\/dc06-9909","article-title":"Diabetic Ketoacidosis in Infants, Children, and Adolescents: A Consensus Statement from the American Diabetes Association","volume":"29","author":"Wolfsdorf","year":"2006","journal-title":"Diabetes Care"},{"key":"ref_12","first-page":"859","article-title":"Diagnosis and Treatment of Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State","volume":"168","author":"Chiasson","year":"2003","journal-title":"CMAJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/j.1399-5448.2009.00516.x","article-title":"Difficulties or Mistakes in Diagnosing Type 1 Diabetes in Children?\u2014Demographic Factors Influencing Delayed Diagnosis","volume":"10","author":"Birkholz","year":"2009","journal-title":"Pediatr. Diabetes"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.2337\/dc24-0625","article-title":"Clinical Outcomes in Pediatric Patients with Type 1 Diabetes with Early Versus Late Diagnosis: Analysis from the DPV Registry","volume":"47","author":"Hammersen","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_15","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":"Hornstein","year":"2018","journal-title":"Horm. Metab. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.4103\/2230-8210.155403","article-title":"Diabetic Ketoacidosis in Children and Adolescents","volume":"19","author":"Raghupathy","year":"2015","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_17","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":"Onyiriuka","year":"2013","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1001\/jama.2014.3201","article-title":"Prevalence of Type 1 and Type 2 Diabetes Among U.S. Youth, 2001\u20132009","volume":"311","author":"Dabelea","year":"2014","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10358","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":"Jefferies","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/000992280304200704","article-title":"Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus","volume":"42","author":"Mallare","year":"2003","journal-title":"Clin. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2550952","DOI":"10.1155\/pedi\/2550952","article-title":"Eighteen-Year Incidence, Health Outcomes and Costs Associated With Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in NSW, Australia","volume":"2025","author":"Bell","year":"2025","journal-title":"Pediatr. Diabetes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.2337\/dc19-1041","article-title":"Medical Costs Among Youth Younger Than 20 Years of Age with and Without Diabetic Ketoacidosis at the Time of Diabetes Diagnosis","volume":"42","author":"Saydah","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/pedi.13379","article-title":"DKA Incidence Among Children with New-Onset Type 1 Diabetes in Poland and Its Association with COVID-19","volume":"23","author":"Pietrzak","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_24","first-page":"272","article-title":"Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents from Wielkopolska Province in Poland: Prevalence, Risk Factors and Clinical Presentation","volume":"7","author":"Michalak","year":"2018","journal-title":"Clin. Diabetol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1001\/jamapediatrics.2022.3586","article-title":"Factors Associated with Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review","volume":"176","author":"Dixon","year":"2022","journal-title":"JAMA Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1111\/pedi.13229","article-title":"Delayed Referral Is Common Even When New-Onset Diabetes Is Suspected in Children. A Swedish Prospective Observational Study of Diabetic Ketoacidosis at Onset of Type 1 Diabetes","volume":"22","author":"Adolfsson","year":"2021","journal-title":"Pediatr. Diabetes"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.jdiacomp.2018.08.011","article-title":"A Mixed Method Approach to Understanding the Factors Surrounding Delayed Diagnosis of Type One Diabetes","volume":"32","author":"Brown","year":"2018","journal-title":"J. Diabetes Complications"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/adc.81.4.318","article-title":"Causes of Death in Children with Insulin Dependent Diabetes 1990\u201396","volume":"81","author":"Edge","year":"1999","journal-title":"Arch. Dis. Child."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2333794X19870394","DOI":"10.1177\/2333794X19870394","article-title":"Diabetic Ketoacidosis at Onset of Type 1 Diabetes: Rates and Risk Factors Today to 15 Years Ago","volume":"6","author":"Mencher","year":"2019","journal-title":"Glob. Pediatr. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s40272-020-00397-0","article-title":"Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus","volume":"22","author":"Castellanos","year":"2020","journal-title":"Pediatr. Drugs"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lan, Y.-Y., Kovinthapillai, R., K\u0119dzia, A., and Niechcia\u0142, E. (2024). Age-Based Challenges to Type 1 Diabetes Management in the Pediatric Population. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1434276"},{"key":"ref_32","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":"Thompson","year":"2012","journal-title":"Diabetologia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3346\/jkms.2017.32.2.303","article-title":"Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents","volume":"32","author":"Lee","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1034\/j.1399-5448.2003.00007.x","article-title":"Ketoacidosis at Onset of Type 1 Diabetes Mellitus in Children: Frequency and Clinical Presentation","volume":"4","author":"Neu","year":"2003","journal-title":"Pediatr. Diabetes"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1515\/jpem-2012-0110","article-title":"Clinical Features and Management of Diabetic Ketoacidosis in Different Age Groups of Children: Children Less than 5 Years of Age Are at Higher Risk of Metabolic Decompensation","volume":"25","author":"Cebeci","year":"2012","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/dme.12252","article-title":"Factors Associated with Diabetic Ketoacidosis at Onset of Type 1 Diabetes in Children and Adolescents","volume":"30","author":"Oren","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1177\/19322968211042656","article-title":"Continuous Ketone Monitoring Consensus Report 2021","volume":"16","author":"Nguyen","year":"2022","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"100231","DOI":"10.1016\/j.deman.2024.100231","article-title":"Predictive Factors of Diabetic Ketoacidosis in Patients with Newly Onset Type 1 Diabetes: A Single Center Study","volume":"16","author":"Benouda","year":"2024","journal-title":"Diabetes Epidemiol. Manag."},{"key":"ref_39","first-page":"65","article-title":"Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis","volume":"5","author":"Mirsadraee","year":"2017","journal-title":"J. Pediatr. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/j.1399-543X.2006.00163.x","article-title":"Association between Infectious Diseases and Type 1 Diabetes: A Case-Crossover Study","volume":"7","author":"Yang","year":"2006","journal-title":"Pediatr. Diabetes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/0002-9343(82)90511-3","article-title":"Infection and Diabetes: The Case for Glucose Control","volume":"72","author":"Rayfield","year":"1982","journal-title":"Am. J. Med."},{"key":"ref_42","first-page":"151","article-title":"Spontaneous Dissemination of DKA Prevention Campaign Successfully Launched in Nineties in Parma\u2019s Province","volume":"88","author":"Cangelosi","year":"2017","journal-title":"Acta Bio. Medica. Atenei. Parm."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.2337\/dc24-0534","article-title":"Family History of Diabetes and Clinical Characteristics in Children at Diagnosis of Type 1 Diabetes\u2014A Swedish Population-Based Study","volume":"47","author":"Hedlund","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/pedi.13454","article-title":"ISPAD Guidelines 2022: Definition, Epidemiology and Classification of Diabetes in Children","volume":"23","author":"Libman","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.2337\/dc25-S002","article-title":"Diagnosis and Classification of Diabetes: Standards of Care in Diabetes\u20142025","volume":"48","author":"ElSayed","year":"2025","journal-title":"Diabetes Care"},{"key":"ref_46","unstructured":"World Health Organization (2025, December 27). Classification of Diabetes Mellitus. Available online: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/2cb3ab68-a52a-402e-ad47-8bc5a4edc834\/content."},{"key":"ref_47","unstructured":"National Institute for Health and Care Excellence (2025, December 27). Overview|Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management|Guidance|NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng18."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jama.2015.9536","article-title":"Diabetes: Advances in Diagnosis and Treatment","volume":"314","author":"Nathan","year":"2015","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.2337\/db22-0097","article-title":"Circulating C-Peptide Levels and \u03b2-Cell Loss Across T1D Duration","volume":"71","author":"Carr","year":"2022","journal-title":"Diabetes"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jped.2016.05.008","article-title":"Diabetic Ketoacidosis in a Pediatric Intensive Care Unit","volume":"93","author":"Lopes","year":"2017","journal-title":"J. Pediatr. Rio. J."},{"key":"ref_51","first-page":"476","article-title":"Diabetic Ketoacidosis: Evaluation and Treatment","volume":"110","author":"Veauthier","year":"2024","journal-title":"Am. Fam. Physician"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e15372","DOI":"10.1111\/dme.15372","article-title":"Ambulance Clinician Use of Capillary Blood Ketone Meters to Improve Emergency Hyperglycaemia Care: A Stepped-Wedged Controlled, Mixed-Methods Feasibility Study","volume":"41","author":"Prothero","year":"2024","journal-title":"Diabet. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee, ElSayed, N.A., McCoy, R.G., Aleppo, G., Balapattabi, K., Beverly, E.A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J.B., and Ekhlaspour, L. (2025). Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes\u20142025. Diabetes Care, 48, S128\u2013S145.","DOI":"10.2337\/dc25-S006"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1159\/000525824","article-title":"Screening of Islet Autoantibodies for Children in the General Population: A Position Statement Endorsed by the European Society for Paediatric Endocrinology","volume":"95","author":"Chiarelli","year":"2022","journal-title":"Horm. Res. Paediatr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e15419","DOI":"10.1111\/dme.15419","article-title":"Protocol for the Australian Type 1 Diabetes National Screening Pilot","volume":"41","author":"Bell","year":"2024","journal-title":"Diabet. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/dom.16522","article-title":"Health Economic Considerations of Screening for Early Type 1 Diabetes","volume":"27","author":"Rewers","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.2337\/dc19-2003","article-title":"Cost and Cost-Effectiveness of Large-Scale Screening for Type 1 Diabetes in Colorado","volume":"43","author":"McQueen","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e15131","DOI":"10.1111\/dme.15131","article-title":"General Population Screening for Paediatric Type 1 Diabetes\u2014A Qualitative Study of UK Professional Stakeholders","volume":"40","author":"Quinn","year":"2023","journal-title":"Diabet. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e70117","DOI":"10.1111\/dme.70117","article-title":"UK Best Practice Recommendations for Children with Pre-Stage 3 Type 1 Diabetes","volume":"42","author":"Besser","year":"2025","journal-title":"Diabet. Med."},{"key":"ref_60","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\u2014The Stuttgart Diabetes Awareness Campaign, Germany","volume":"21","author":"Holder","year":"2020","journal-title":"Pediatr. Diabetes"},{"key":"ref_61","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. An 8-Year Study in Schools and Private Practices","volume":"22","author":"Vanelli","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_62","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":"King","year":"2012","journal-title":"Pediatr. Diabetes"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/pedi.12666","article-title":"Diabetic Ketoacidosis Incidence in Children at First Presentation of Type 1 Diabetes at an Australian Regional Hospital: The Effect of Health Professional Education","volume":"19","author":"Patwardhan","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_64","first-page":"1059","article-title":"Frequency and Severity of Ketoacidosis at Onset of Autoimmune Type 1 Diabetes over the Past Decade in Children Referred to a Tertiary Paediatric Care Centre: Potential Impact of a National Programme Highlighted","volume":"26","author":"Saka","year":"2013","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1515\/jpem-2015-0077","article-title":"Reduced Frequency and Severity of Ketoacidosis at Diagnosis of Childhood Type 1 Diabetes in Northwest Saudi Arabia","volume":"29","author":"Ahmed","year":"2016","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.jcjd.2021.03.013","article-title":"A Multi-Intervention Campaign Lowers Pediatric and Young Adult Diabetic Ketoacidosis Hospitalizations in a Canadian Province","volume":"45","author":"Darmonkow","year":"2021","journal-title":"Can. J. Diabetes"},{"key":"ref_67","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":"Derraik","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1484","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":"Fritsch","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_69","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 a Publicity Campaign","volume":"29","author":"Lansdown","year":"2012","journal-title":"Diabet. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/archdischild-2019-316903","article-title":"DKA at Onset During a National Awareness Campaign: A 2-Year Observational Study","volume":"105","author":"Rabbone","year":"2020","journal-title":"Arch. Dis. Child."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"108838","DOI":"10.1016\/j.diabres.2021.108838","article-title":"Effectiveness of Ketoacidosis Prevention Campaigns at Diagnosis of Type 1 Diabetes in Children: A Systematic Review and Meta-Analysis","volume":"175","author":"Cherubini","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.pedhc.2022.07.004","article-title":"Delayed Management of Insulin-Dependent Diabetes Mellitus in Children","volume":"37","author":"Tas","year":"2023","journal-title":"J. Pediatr. Health Care"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"164","DOI":"10.14740\/jocmr6180","article-title":"Predictive Factors for Diagnosing Diabetic Ketoacidosis or Simple Hyperglycemia in Adults with High Blood Glucose: The \u201c1-DKA Alert\u201d Study","volume":"17","author":"Peamyao","year":"2025","journal-title":"J. Clin. Med. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1016\/S0140-6736(21)02247-9","article-title":"A Century Past the Discovery of Insulin: Global Progress and Challenges for Type 1 Diabetes among Children and Adolescents in Low-Income and Middle-Income Countries","volume":"398","author":"Bhutta","year":"2021","journal-title":"Lancet"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/pedi.12066","article-title":"Children in the TEDDY Study Are Diagnosed with T1D at an Early Stage","volume":"15","author":"Vehik","year":"2014","journal-title":"Pediatr. Diabetes"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1007\/s00125-021-05514-3","article-title":"Characteristics of Children Diagnosed with Type 1 Diabetes before vs after 6 Years of Age in the TEDDY Cohort Study","volume":"64","author":"Krischer","year":"2021","journal-title":"Diabetologia"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/s00125-023-05953-0","article-title":"Children Diagnosed with Presymptomatic T1D Through Public Health Screening Have Milder Diabetes","volume":"66","author":"Hummel","year":"2023","journal-title":"Diabetologia"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1007\/s00125-022-05780-9","article-title":"Progression Likelihood Score Identifies Substages of Presymptomatic T1D in Childhood Screening","volume":"65","author":"Weiss","year":"2022","journal-title":"Diabetologia"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00592-015-0751-y","article-title":"Prediction of T1D in Sardinian Schoolchildren Using Islet Cell Autoantibodies: 10-Year Follow-Up","volume":"53","author":"Velluzzi","year":"2016","journal-title":"Acta Diabetol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.2337\/dc18-2282","article-title":"Predicting Islet Autoimmunity and T1D: An 8-Year TEDDY Progress Report","volume":"42","author":"Krischer","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.2337\/dc19-2547","article-title":"Hierarchical Order of Distinct Autoantibody Spreading and Progression to Type 1 Diabetes in the TEDDY Study","volume":"43","author":"Vehik","year":"2020","journal-title":"Diabetes Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/533\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:22:38Z","timestamp":1767946958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":81,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020533"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020533","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}