Effectiveness of Diabetes Symptoms Awareness Campaigns on Preventing Diabetes Ketoacidosis at Diagnosis of Type 1 Diabetes: A Systematic Review and Meta-Analysis

Abstract

Background: Despite efforts to promote an early type 1 diabetes diagnosis, Diabetic Ketoacidosis (DKA) amongst children and adolescents worldwide remains high. This article evaluated the effectiveness of intervention campaigns aimed at reducing the frequency of DKA at type 1 diabetes diagnosis in children and adolescents. Methods: The search strategies included PubMed, Scopus, CINAHL and Web of Science electronic databases, a hand search of select journals and grey literature. Studies included community-based interventions that assessed variation in the frequency of DKA related to awareness campaign interventions focused on children and adolescents younger than 18 years old. The difference in DKA frequency was measured in two separate comparisons. DKA frequency at diabetes diagnosis before and after intervention campaigns, and the difference in DKA frequency between areas with and without and intervention. Findings: Of 1136 records identified, 14 studies were eligible for the analysis. The first group of 12 studies measured DKA at diagnosis, before (n=6548 individuals) and after (n=4931 individuals) the awareness campaigns. The pooled difference in DKA frequency before and after an awareness campaign was 7.20% (95%CI: 0.99-13.41) The second group of four studies measured the difference in an area with no intervention (n=338 individuals) and in an area with an awareness campaign (n=187 individuals). The pooled difference in DKA was 35.71% (95%CI: 5.81-65.61). Interpretation: This review demonstrated that DKA awareness campaigns are effective to reduce DKA among children and adolescents with type 1 diabetes. Moreover, this study demonstrated why these campaigns are effective as it summarized the core components contributing to outcomes. These components can guide future intervention campaigns and serve as the basis for future research. Funding Statement: None. Declaration of Interests: No potential conflicts of interest relevant to this article were reported.