Johan Wersäll: Preventing diabetic ketoacidosis in children
Diabetic ketoacidosis is a life-threatening complication of diabetes. In Sweden, children from low-income households face a 40 percent higher risk of developing ketoacidosis before their diabetes is identified, as revealed in Johan Wersäll’s doctoral thesis.
JOHAN WERSÄLL
Dissertation Defense: December 6, 2023 (click for details)
Doctoral thesis: Risk Factors for Diabetic Ketoacidosis in Children
Research area: Anesthesiology and Intensive Care
Sahlgrenska Academy, The Institute of Clinical Sciences
When insulin is deficient, glucose cannot enter cells, accumulating in the blood and causing increasing glucose levels in urine. Frequent urination, intense thirst, fatigue, and weight loss are typical symptoms. Increased fat breakdown leads to blood acidity and nausea.
The condition is termed diabetic ketoacidosis (DKA). Without insulin treatment, this complication progresses to unconsciousness and ultimately death.
“Potentially preventable”
Over 20 percent of Swedish children diagnosed with type 1 diabetes develop ketoacidosis before diagnosis.
“This is a potentially preventable condition. Increasing societal awareness of early diabetes symptoms could spare many children from DKA,” says Johan Wersäll, an anesthesiologist and intensive care doctor at Sahlgrenska University Hospital.
How do we improve awareness within both the population and healthcare system?
“Large-scale awareness campaigns, like those in Italy and France, have proven effective. Poster campaigns in health centers and schools have significantly reduced DKA cases.”
Johan Wersäll’s research indicates that almost 60 percent of newly diagnosed diabetic children with ketoacidosis had been in contact with primary care within the previous four weeks. Over 40 percent of these children faced delayed hospital admissions despite displaying diabetes-related symptoms at primary healthcare contacts.
Low income as a risk factor
One study within the thesis investigated the link between DKA and economic status. Wersäll used a standardized European definition of ‘low economic standard’, which refers to a disposable income below 60 percent of the country’s median value.
“Our study revealed a strong correlation. Children from low-income households faced over a 40 percent increased risk of developing ketoacidosis.
Screening of children
Apart from information campaigns, what else can society do to reduce diabetic ketoacidosis in children?
“Screening could be crucial in ensuring timely diabetes treatment before acute complications arise,” Wersäll suggests. “Italy now mandates screening for schoolchildren of a certain age.”
How does this type of screening work?
“It involves a blood test for antibodies against insulin-producing cells. These values enable a relatively precise prediction of type 1 diabetes risk within five years. In this way, children at increased risk can be identified, followed up and treated early if they develop the disease. This way, diabetic ketoacidosis could hopefully be prevented to a large extent.”
Text: Jakob Lundberg