Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014-2016 Nationwide Study of 2,679 Italian Children

Rosaria Gesuita; Claudio Maffeis; Riccardo Bonfanti; Francesca Cardella; Felice Citriniti; Giuseppe D'Annunzio; Adriana Franzese; Dario Iafusco; Antonio Iannilli; Fortunato Lombardo; Giulio Maltoni; Ippolita Patrizia Patera; Elvira Piccinno; Barbara Predieri; Ivana Rabbone; Carlo Ripoli; Sonia Toni; Riccardo Schiaffini; Renee Bowers; Valentino Cherubini; Network of the Italian Society of Pediatric Endocrinology and Diabetes (ISPED) for DKA Study and Prevention

doi:10.3389/fped.2020.575020

Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014-2016 Nationwide Study of 2,679 Italian Children

Front Pediatr. 2020 Oct 22:8:575020. doi: 10.3389/fped.2020.575020. eCollection 2020.

Authors

Rosaria Gesuita¹, Claudio Maffeis², Riccardo Bonfanti³, Francesca Cardella⁴, Felice Citriniti⁵, Giuseppe D'Annunzio⁶, Adriana Franzese⁷, Dario Iafusco⁸, Antonio Iannilli⁹, Fortunato Lombardo¹⁰, Giulio Maltoni¹¹, Ippolita Patrizia Patera¹², Elvira Piccinno¹³, Barbara Predieri¹⁴, Ivana Rabbone¹⁵, Carlo Ripoli¹⁶, Sonia Toni¹⁷, Riccardo Schiaffini¹², Renee Bowers¹⁸, Valentino Cherubini⁹; Network of the Italian Society of Pediatric Endocrinology and Diabetes (ISPED) for DKA Study and Prevention

Affiliations

¹ Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.
² Pediatric Diabetes and Metabolic Disorders Unit, University of Verona School of Medicine and Surgery, Verona, Italy.
³ Department of Pediatrics, San Raffaele Institute, Milan, Italy.
⁴ Division of Pediatrics, Ospedale dei Bambini, Palermo, Italy.
⁵ Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy.
⁶ Pediatric Clinic and Endocrinology, Regional Reference Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁷ Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II School of Medicine and Surgery, Naples, Italy.
⁸ Department of Pediatrics, Regional Center of Pediatric Diabetology "G. Stoppoloni", University of Campania "Luigi Vanvitelli", Naples, Italy.
⁹ Department of Women's and Children's Health, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy.
¹⁰ Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy.
¹¹ Department of Pediatrics, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy.
¹² Ospedale Pediatrico Bambino Gesù, Endocrinology and Diabetes Unit, Roma, Italy.
¹³ Unitá Operativa Complessa (UOC) Malattie Metaboliche e Diabetologia, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
¹⁴ Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
¹⁵ Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Vercelli, Italy.
¹⁶ Department of Pediatrics, Azienda Ospedaliera G. Brotzu Cagliari, Cagliari, Italy.
¹⁷ Meyer Children's Hospital, Pediatric Endocrinology and Diabetology Unit, Firenze, Italy.
¹⁸ Population Health, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.

Abstract

This study aims to compare the frequency of Diabetic Ketoacidosis (DKA) at diagnosis in 2014-2016 with the one previously reported in 2004-2013; and to assess the association between family socioeconomic status and DKA at type 1 diabetes (T1D) diagnosis in children <15 years of age from 2014 to 2016. Methods: This nationwide, population-based, observational study included 2,679 children diagnosed with T1D from 54 Italian centers for pediatric diabetes during 2014-2016. The ISPAD criteria for DKA were used as a standard reference. The overall and by age frequency of DKA between the two time periods were compared. The association between family socioeconomic status and DKA was assessed using multiple logistic regression analysis. Results: Nine hundred and eighty nine children had DKA (36.9, 95% CI: 35.1-38.8). The frequency of DKA was significantly lower in 2014-2016 in comparison to 2004-2013 (40.3, 95% CI: 39.3-41.4, p = 0.002). The probability of having DKA at diagnosis was lower in mothers with a high level of education (OR = 0.69, 95% CI: 0.51-0.93) or a high level of occupation (OR = 0.76, 95% CI: 0.58 0.99), and in fathers with a high level of occupation (OR = 0.72, 95% CI: 0.55-0.94). Children living in Southern Italy had a higher probability of diagnosis with severe DKA than children living in Central Italy. Conclusion: There was a decrease in the frequency of DKA in children diagnosed with T1D under 15 years of age during 2014-2016. However, DKA frequency remains unacceptably high. This study demonstrated that socioeconomic inequalities, measured as low education and occupational levels, were associated with an increased probability of DKA at T1D diagnosis.

Keywords: DKA (diabetic ketoacidosis); children; inequalities; socioeconomic factors; type 1 diabetes (T1D).

Copyright © 2020 Gesuita, Maffeis, Bonfanti, Cardella, Citriniti, D'Annunzio, Franzese, Iafusco, Iannilli, Lombardo, Maltoni, Patera, Piccinno, Predieri, Rabbone, Ripoli, Toni, Schiaffini, Bowers, Cherubini and Network of the Italian Society of Pediatric Endocrinology and Diabetes (ISPED) for DKA Study and Prevention.