Doctors sound alarmDoctors are calling for better diabetes awareness as almost 1 in 5 children with diabetes develop a dangerous complication known as Diabetic Ketoacidosis (DKA)– a lack of insulin in the body – before they are officially diagnosed with the condition.

Furthermore, rates of DKA, in those already diagnosed with diabetes remain high and are highest in females aged between 10 and 19 in England and Wales, according to a report from the National Paediatric Diabetes Audit (NPDA), published today by the Royal College of Paediatrics and Child Health.

If left untreated, DKA can cause mental confusion, rapid heartbeat and breathing, sickness and unconsciousness and can be life threatening if not diagnosed and treated urgently.

Dr Justin Warner, RCPCH's Clinical Lead for the NPDA and a Consultant in Paediatric Endocrinology and Diabetes, said: "Managing diabetes in childhood is a complex problem requiring close collaboration and partnership between the child, family and healthcare teams. An admission to hospital for an acute complication, such as DKA, in a child with established diabetes, can be deemed as a failure of that partnership."

"Understanding the mechanisms which may lead up to an acute admission in a child with diabetes is often difficult, particularly in teenagers who are being encouraged to take on responsibility for their own care."

Further reading: 'Concerns over rise in child diabetes'

The audit which was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Patient Outcomes Programme (NCAPOP), identified 6,210 hospital admissions out of 25,199 children and young people under the age of 25 with diabetes for 2011-12 who are cared for in 177 paediatric centres across England and Wales.

The audit also found that:

  • About half of all hospital admissions in children with diabetes are related to acute complications including DKA and hypoglycaemia (low blood sugar)
  • The number of admissions for DKA remain high but have improved since 2010-11
  • Females tend to have higher rates of DKA admissions than males: (11.6% and 8.9% of females with diabetes in England and Wales respectively compared to 7.7% and 5.0% for males)
  • Nearly 1 in 10 admissions to hospital of children and young people with diabetes is as a result of a hypoglycaemic episode.

Dr Warner added: "It is encouraging to see a fall in the DKA rate for 2011-12 compared to previous years in some age groups, but for this trend to continue, more emphasis on structured education is needed to prevent the admissions in the first place."

"The public and healthcare professionals who come into contact with children need to be more aware of the symptoms of diabetes, allowing earlier diagnosis and speedy treatment so as to avoid complications of DKA at diagnosis."

In November 2012, Diabetes UK launched the 4T's campaign to raise awareness of the four most common symptoms of diabetes in children - Thirst (not being able to quench a thirst), Toilet (frequently needing to go to the toilet), Tired (feeling more tired than usual) and Thinner (losing weight). If you recognise these symptoms in a child then urgent medical advice should be sought.

Bridget Turner, Director of Policy and Care Improvement at Diabetes UK, said: "It is important that doctors are calling for better diabetes awareness. By making parents aware of the symptoms of Type 1 diabetes, we can help make sure children have the best possible chance of being diagnosed quickly and avoiding complications.

"This audit has identified the real problem that one in five children with diabetes develops complications like DKA.

"Although parents are now more aware of the main symptoms, the 4 Ts of Type 1 diabetes, than they were a year ago, there is still a long way to go, as parents who are aware of all four symptoms are still the exception rather than the rule.

"Because children with Type 1 diabetes might have just one or two of the symptoms, it is important that parents know them all and also understand that if their child has any of them then they should take them straight to the GP."