New RI-MUHC study of international data suggests awareness and access to care are key factors in improving outcomes for diabetic children

SOURCE: RI-MUHC. Type 1 diabetes is one of the most common chronic diseases of childhood. Yet in Canada, 19-25% of children with type 1 diabetes will not be diagnosed until they show symptoms of a potentially deadly complication known as diabetic ketoacidosis (DKA). DKA can be life-threatening and can have long term detrimental effects.

This week in the Journal of the American Medical Association Pediatrics, researchers from the Montreal Children’s Hospital and the Research Institute of the McGill University Health Centre (RI-MUHC) presented the results of an international study demonstrating the importance of increased awareness of the symptoms of type 1 diabetes to prevent DKA in children. The study underscores the need to increase physician and public awareness of the signs and symptoms of childhood diabetes before DKA develops.

Led by Meranda Nakhla MD, M.Sc., a pediatric endocrinologist at the Montreal Children's Hospital and scientist at the RI-MUHC, this study prospectively followed a group of 2,159 children at increased genetic risk of type 1 diabetes from birth. Data from the international Trial to Reduce Insulin Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR) showed that approximately 4.6% of these children presented in DKA at the time of type 1 diabetes diagnosis, a reduced risk compared to the general population.

“Within research settings, there is arguably an increased awareness of diabetes risk and symptoms provided by the research teams, leading to earlier diagnosis and a decreased DKA risk at disease onset,” says Dr. Nakhla, who is a member of the Child Health and Human Development Program (CHHD) and conducts research at the Centre for Outcomes Research and Evaluation at the RI-MUHC.

“We did observe regional disparities,” says Laurent Legault, MD, coauthor of the study, a scientist in the CHHD Program and co-investigator in the TRIGR study. “In the US, 12.5% of children newly diagnosed with type 1 diabetes presented in DKA. In Canada, where children have access to universal healthcare coverage, the rate was only 2.2%. Our findings necessitate future exploration of whether healthcare availability and access are underlying drivers of these observed regional differences.”

“The annual global incidence of type 1 diabetes is increasing by 3-5%, and we have previously shown that rates of DKA are increasing in Quebec,” adds Dr. Nakhla. “Some studies suggest families' reduced access to healthcare during the COVID-19 pandemic may even be leading to higher rates of this preventable and dangerous complication.”

Additional studies have also shown that having a primary care provider decreases the risk of DKA. The authors of this current international study emphasize that increased awareness of the symptoms of type 1 diabetes is essential for preventing DKA at diagnosis, in particular the need to increase physician and public awareness of the signs and symptoms of childhood diabetes before DKA develops.

About the study:
Nakhla M, Cuthbertson D, Becker DJ, et al. Diabetic Ketoacidosis at the Time of Diagnosis of Type 1 Diabetes in Children: Insights From TRIGR. JAMA Pediatr. Published online January 25, 2021. doi:10.1001/jamapediatrics.2020.5512

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January 25, 2021