Table 1.
Summary of the findings of the 15 studies included in this review.
| Study (Author, Year) | Region | Children with T1D Onset Age and Number; Population Target of the Campaign | Description of Intervention | Duration | Results | ||||
|---|---|---|---|---|---|---|---|---|---|
| Frequency of DKA | Complications | HbA1c | C-Peptide | Hospitalization and Costs | |||||
| Vanelli et al., 1999 [17] |
Italy, Parma | 6–14 years 438,232 Students, family with young children, schoolteachers, primary care physicians |
Educational session of 1-h duration to general pediatricians. Posters about medical information of DKA. Postcards with criteria for the diagnosis of T1D according to the WHO. Devices for measurement of capillary blood glucose and glycosuria Toll-free information phone number. |
8 years (1991–1998) | Decrease in rate of DKA from 78% to 12.5% (p < 0.0001) in the province of Parma vs control provinces. Decreased frequency of DKA from 83% to 12.5% in children from Parma vs. from two nearby areas. |
- | Decreased rate of HbA1c from 14.5% to 9.4% in children from control provinces vs from Parma. | Increased level of C-peptide C from 0.12 to 0.15 ng/mL in children from Parma vs. from two nearby areas. | Reduction in length of hospitalization from 13.3 days to 5.4 days in patients from Parma vs. from Reggio Emilia and Piacenza. The total cost of the campaign was USD 23,470. Lower cost from treatment and education from USD 196,457 to USD 53,356 in patients without DKA vs. with DKA. |
| Vanelli et al., 2008 [18] |
Italy, Parma | 6–14 years not mentioned Students, family with young children, schoolteachers, general pediatrician |
Poster indicating early symptoms of T1D, flyers with guidelines about T1D diagnosis. | 8 years (1998–2006) | Reduction in DKA frequency from 27% to 19% (p < 0.0001) in the province of Parma vs. control provinces. | - | - | - | The total cost of the campaign was $23,470. |
| Jelley et al., 2010 [19] |
USA, Oklahoma | Not mentioned 193 Students, schoolteachers, primary care physicians |
Informational posters, postcards indicating early symptoms, media blitz on local television, advertising on a regional newspaper. | 6 months (2009) | Decreased rate of DKA from 29.9% to 23% in the year of the campaign vs. 6 months before it (p < 0.05). | - | - | - | The total cost of the campaign was USD 1100. |
| King et al., 2012 [20] |
Australia, Gosford | 0–18 years 328 Schoolteachers, primary care physicians. |
Posters and postcards. Educational session. Glucose and ketone testing equipment. A toll-free diabetes information phone number. | 2 years (2008–2010) | Reduction in DKA frequency from 37.5% to 13.8% (p < 0.03). Any change in the control regions. |
- | - | - | - |
| Lansdown et al. 2012 [21] |
UK, Wales | <15 years 3033 Schoolteachers, primary care physicians |
Advertising posters. Television and radio interviews about symptoms and late diagnosis. | 19 years (1991–2009) | Non statistically significant reduction in DKA frequency from 27.5% to 25.6% (p < 0.72). | - | - | - | - |
| Fritsch et al., 2013 [22] |
Austria, Vienna | <15 years 4038 General population, kindergartens, primary and secondary schools, pharmacies, primary care physicians. |
Posters focused on early symptoms of DKA. Medical journals about DKA. Educational sessions about diabetes and DKA. Broadcast in tv and articles on regional newspaper. | 22 years (1989–2011) | Non-significant reduction in DKA frequency from 37.8% to 36.8% (p > 0.05). | - | - | - | - |
| Uçar et al., 2013 [23] |
Turkey, Istanbul | 8–5 years (0.5–17.5 years) 401 General population, family, students, schoolteachers. |
Awareness posters and brochure on diabetes. Educational material on specific websites. | 2 years (2011–2012) | Decreased DKA frequency from 49.3% to 23.9% (p < 0.001) in patients of 2011–2012 vs. the ones of 2003–2010 | - | - | - | - |
| Choleau et al., 2014 [24] |
France | <15 years 1299 General population, schoolteachers, primary care physicians. |
National information campaign. Publication on general and specific newspapers. Posters. Interviews and spots on national and regional televisions and radios. | 1 year (2009) | Decreased frequency of DKA from 43.9% to 40.5% after 1 year (p = 0.08). | In DKA vs. not DKA: loss of consciousness 30.2% vs. 0.30%, deep coma 3.2% vs. 0 and of hospitalization in Intensive Care Units 53.6% vs. 5.3% | - | - | - |
| Ahmed et al., 2015 [25] |
North of Saudi Arabia | <12 years 541 General population, family, schoolteachers, primary care physicians. |
Educational interventions and sessions. Poster and flyers. Media coverage. | 4 years (2010–2014) | Reduction in DKA frequency from 48% to 39% (p < 0.01) | Any severe complications during the intervention years. Rates of mortality and morbidity of DKA cohort were comparable to other population-based studies. | Decreased rate of HbA1c from 10.0% to 9.1% after the campaign (p < 0.001) | - | - |
| Cangelosi et al., 2017 [26] |
Italy, Parma | 6–14 years 135 General population, schoolteachers, primary care physicians. |
Poster and leaflets. Local radio announcements. |
5 years (2012–2016) | Decreased rate of DKA frequency from 52.7% to 5.9% in children from province of Parma vs. from two other nearby provinces (p = 0.002). | No cases of severe DKA. | Decreased rate of HbA1c from 13.6% to 9.9% in patients without DKA vs. with DKA. | - | - |
| Patwardhan et al., 2018 [27] |
Australia, Queensland | Age: 0–18 years 106 Health professionals |
Educational section of 1-h duration. | 1 year (2015–2016) | Reduction in rate of DKA frequency from 54.9% to 25% (p = 0.01). | Decreased rate of severe and moderate DKA and a decrease in patients being admitted to the ICU for DKA at first presentation. Increase in rate of cerebral oedema from 0.5–0.9% to 1.96% in median vs. in patients with DKA during this study. |
Reduction in rate of HbA1c from 12.74% to 11.45% in patients without DKA vs. with DKA (p = 0.09). | - | - |
| Derraik et al., 2018 [28] |
New Zealand. Auckland | <16 years 460,000 General population, primary care physicians |
Posters delivered to mailboxes of individual residential households and to general practitioners and surgery staff to be displayed in waiting rooms. | 2 years (2015–2017) | Increase in rate of DKA frequency from 27% to 28.8%. | - | in rate of HbA1c from 12.5% to 11.8% in patients without DKA vs. with DKA (p = 0.28). | - | The total cost of the campaign was USD 40,107. This campaign prevented three cases of DKA, which means it saved approximately from USD 13,369 to USD 33,569 per case. Decreased in rate of hospitalization from 5.5 days to 4.7 days in not DKA cohorte vs. DKA cohorte. |
| Rabbone et al., 2020 [29] |
Italy | 0–18 years Number: 2361 children and 250 schools |
A national awareness campaign. Poster and bimonthly magazine with information regarding diabetes symptoms. Short commercial on tv and announcements on national and regional television channels. | 2 years (2015–2017) | Increase in rate of DKA frequency from 38.5% to 47.6% (p = 0.002). | Decreased rate of cerebral oedema from 0.53% to 0.35% after intervention. | - | - | - |
| Holder & Ehehalt, 2020 [30] |
Germany, Stuttgart | 0–18 years with median age 4.5 years 44,000 General population, schoolteachers, family, students, pharmacists, pediatrician |
Lecture to schoolteachers Public posters, flyers, newsletters illustrating typical clinical symptoms of T1D. |
3 years (2015–2017) | Decreased DKA frequency from 28.3% to 16.1% in patients of 2015–2017 vs. 2011–2013 (p < 0.02). | - | Decreased HbA1c of 1.4% in patients without DKA vs. with DKA (p < 0.0001) | - | - |
| Darmonkow et al., 2021 [31] |
Canada, Québec | <25 years 232 General population, family, students, schoolteachers, primary care physicians, pharmacists. |
Educational sections, posters, and a DKA prevention kit. | 6 years: three periods of 2 years each (2009–2010, 2011–2012, 2013–2014) | - | - | - | - | Decrease in hospitalization for DKA from 45.8% to 40.6% after vs. before the campaign in children from 0 to 19 years old. |