MMPAD Munich Meeting Report
MEETING REPORT 6 European Roadshow - Friday 25 th May, 2018 Munich, Germany New perspectives on early type 1 diabetes While previous nomenclatures only differentiated between prediabetes and diabetes, type 1 diabetes is now categorised into four stages by the International Society for Pediatric and Adolescent Diabetes (ISPAD) . 2 Holl said that even if the diagnosis of type 1 diabetes in children and adolescents through its symptoms seems to be simple, often neither an early diagnosis nor the prevention of diabetic ketoacidosis (DKA) is achieved despite repeated visits to the paediatrician or emergency room. Consequentially, DKA rates at diabetes onset have not dropped in Germany, Austria and many other countries in recent years. To complicate matters even further, hyperglycaemia during, for example, acute infections, trauma-associated stress and other origins of stress, is merely transitory and not diagnostic for diabetes. Holl also warned of hasty diagnoses in young children with gastroenteritis because elevated blood sugar levels might be transitory. He suggested the continuous monitoring of fasting and postprandial plasma glucose concentrations and use of the oral glucose tolerance test (OGTT). According to the guidelines, there are four criteria for a diagnosis of diabetes mellitus, of which the first (clinical symptoms and blood sugar levels above 200 mg/dL) is essential, particularly in the diagnosis of children, the speaker said. Can we prevent type 1 diabetes? "Paediatricians are always convinced that preventing an ailment is better than curing it," Holl said. But when can we prevent type 1 diabetes: at the beginning; at the stage of clinical diabetes (stage 3); when it is autoimmune deficiency (stage 1) in patients with genetic risks? An Italian study showed that a campaign involving the education of parents and physicians helped to permanently reduce the DKA rate from 80.9% to 15.6%. Yet this has not been confirmed by studies of separate awareness campaigns held in Stuttgart, Germany and in Austria . 3 Lowering the DKA risk in children from families with type 1 diabetes, on the other hand, does work well, Holl said. An extract from Professor Holl's presentation is available here
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