C. D. Mathers and D. Loncar, Projections of Global Mortality and Burden of Disease from 2002 to 2030, PLOS Med, vol.3, issue.11, p.442, 2006.

, Worldwide trends in diabetes since 1980 : a pooled analysis of 751 population-based studies with 4,4 million participants, The Lancet, vol.387, pp.1513-1543, 2016.

A. Fagot-campagna, Y. Dossou, C. Fournier, A. Penfornis, and E. Eschwege, Épidémiologie du diabète de type 1, Rev Prat Médecine Générale, vol.26, issue.881, pp.366-374, 2012.

P. Barat and C. Lévy-marchal, Épidémiologie des diabètes sucrés chez l'enfant, Arch Pédiatr, vol.20, issue.S4, pp.110-116, 2013.

, The DIAMOND Project Group. Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999, Diabet Med, vol.23, issue.8, pp.857-66, 2006.

C. C. Patterson, G. G. Dahlquist, E. Gyürüs, A. Green, and G. Soltész, Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20 : a multicentre prospective registration study. The Lancet, vol.373, pp.2027-2060, 2009.

. Eurodiab-ace-study and . Group, Variation and trends in incidence of childhood diabetes in Europe, The Lancet, vol.355, issue.9207, pp.873-879, 2000.

P. Barat, A. Valade, P. Brosselin, C. Alberti, S. Maurice-tison et al., The growing incidence of type 1 diabetes in children : The 17-year French experience in Aquitaine, Diabetes Metab, vol.34, issue.6, pp.601-606, 2008.

F. Mauny, M. Grandmottet, C. Lestradet, J. Guitard, D. Crenn et al., Analysis of age and period effects from 1980 to 1998, Eur J Epidemiol, vol.20, issue.4, pp.325-334, 2005.
URL : https://hal.archives-ouvertes.fr/hal-00453117

E. J. Mayer-davis, J. M. Lawrence, D. Dabelea, J. Divers, S. Isom et al., Incidence Trends of Type 1 and Type 2 Diabetes among Youths, N Engl J Med, vol.376, issue.15, pp.1419-1448, 2002.

J. A. Edge, M. E. Ford-adams, and D. B. Dunger, Causes of death in children with insulin dependent diabetes 1990-96, Arch Dis Child, vol.81, issue.4, p.318, 1999.

A. Neu, A. Willasch, S. Ehehalt, R. Hub, and M. B. Ranke, Ketoacidosis at onset of type 1 diabetes mellitus in children -frequency and clinical presentation, Pediatr Diabetes, vol.4, issue.2, pp.77-81, 2003.

A. Rewers, G. Klingensmith, C. Davis, D. B. Petitti, C. Pihoker et al., Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth : The Search for Diabetes in Youth Study, Pediatrics, vol.121, issue.5, p.75, 2008.

K. Lokulo-sodipe, R. J. Moon, J. A. Edge, and J. H. Davies, Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK, Arch Dis Child, vol.99, issue.5, pp.438-480, 2014.

M. Julie, Fréquence de l'acidocétose au diagnostic du diabète de type 1 chez l'enfant et l'adolescent en France : analyse descriptive d'une année de recueil de données dans 146 services de pédiatrie, 2012.

M. Oyarzabal-irigoyen, G. Cuartero, B. , B. Castellanos, R. et al., Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature, Pediatr Endocrinol Rev, vol.9, issue.3, pp.669-71, 2012.

C. Choleau, J. Maitre, F. Pierucci, A. Elie, C. Barat et al., Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents, Diabetes Metab, vol.40, issue.2, pp.137-179, 2014.
URL : https://hal.archives-ouvertes.fr/hal-01877847

J. Doutreix and C. Levy-marchal, Diagnostic du diabète insulino-dépendant de l'enfant : données du registre d'incidence. Rev Epidémiologie Santé Publique, vol.44, pp.90-96, 1996.

J. A. Usher-smith, M. Thompson, A. Ercole, and F. M. Walter, Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children : a systematic review, Diabetologia, vol.55, issue.11, pp.2878-94, 2012.

H. Duplan, S. Fosse, C. Lévy-marchal, and A. Fagot-campagna, Séjours hospitaliers pour complications métaboliques aiguës chez les jeunes diabétiques (1-19 ans) : données du PMSI 2003. Journées de veille sanitaire, 2006.

C. Lévy-marchal, A. Fagot-campagna, and M. Daniel, Surveillance épidémiologique du diabète de l'enfant. Institut national de la santé et de la recherche médicale (INSERM), 2007.

A. Neu, S. Ehehalt, A. Willasch, M. Kehrer, R. Hub et al., Varying clinical presentations at onset of type 1 diabetes mellitus in children -epidemiological evidence for different subtypes of the disease ?, Pediatr Diabetes, vol.2, issue.4, pp.147-53, 2001.

E. F. Roche, A. Menon, D. Gill, and H. Hoey, Clinical presentation of type 1 diabetes, Pediatr Diabetes, vol.6, issue.2, pp.75-83, 2005.

J. A. Usher-smith, M. J. Thompson, H. Zhu, S. J. Sharp, and F. M. Walter, The pathway to diagnosis of type 1 diabetes in children : a questionnaire study, BMJ Open, vol.5, p.6470, 2015.

E. J. Mayer-davis, A. R. Kahkoska, C. Jefferies, D. Dabelea, N. Balde et al., Definition, epidemiology, and classification of diabetes in children and adolescents, Clinical Practice Consensus, vol.19, issue.S27, pp.7-19, 2018.

P. Drouin, J. F. Blickle, B. Charbonnel, E. Eschwege, P. J. Guillausseau et al., Diagnostic et classification du diabète sucré Les nouveaux critères, Diabetes Metab, vol.25, issue.1, pp.72-83, 1999.

H. Bui, T. To, R. Stein, K. Fung, and D. Daneman, Is Diabetic Ketoacidosis at Disease Onset a Result of Missed Diagnosis ?, J Pediatr, vol.156, issue.3, pp.472-479, 2010.

M. Paw?owicz, D. Birkholz, M. Nied?wiecki, and A. Balcerska, Difficulties or mistakes in diagnosing type 1 diabetes mellitus in children ? The consequences of delayed diagnosis, Pediatr Endocrinol Diabetes Metab, vol.14, issue.1, pp.7-12, 2008.

F. Harun, Misdiagnoses of diabetic ketoacidosis in childhood, Pediatr Diabetes, vol.6, issue.S3, p.40, 2005.

N. Blanc, N. Lucidarme, and N. Tubiana-rufi, Facteurs associés à l'acidocétose révélatrice du diabète de l'enfant et à sa sévérité, Arch Pédiatr, vol.10, issue.4, pp.320-325, 2003.

C. Hermant, Connaissances des médecins généralistes d'Ille-et-Vilaine concernant le diagnostic de diabète de type 1 chez l'enfant, 2015.

M. Vanelli, G. Chiari, L. Ghizzoni, G. Costi, T. Giacalone et al., Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices, Diabetes Care, vol.22, issue.1, pp.7-9, 1999.

H. Keen, Diabetes diagnosis, International Textbook of Diabetes Mellitus, 1992.

M. Vanelli, G. Chiari, S. Lacava, and B. Iovane, Campaign for Diabetic Ketoacidosis Prevention Still Effective 8 Years Later. Diabetes Care, vol.30, p.12, 2007.

B. R. King, N. J. Howard, C. F. Verge, M. M. Jack, N. Govind et al., A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes, Pediatr Diabetes, vol.13, issue.8, pp.647-51, 2012.

C. Choleau, J. Maitre, C. Elie, P. Barat, A. M. Bertrand et al., Effet à un an de la campagne nationale de prévention de l'acidocétose au moment du diagnostic de diabète de type 1 chez l'enfant et l'adolescent, Arch Pédiatr, vol.22, issue.4, pp.343-51, 2015.

J. T. Mallare, C. C. Cordice, B. A. Ryan, D. E. Carey, P. M. Kreitzer et al., Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1

, Diabetes Mellitus. Clin Pediatr, vol.42, issue.7, pp.591-598, 2003.

M. Rodacki, J. Pereira, A. De-oliveira, B. Barone, R. M. Dowell et al., Ethnicity and young age influence the frequency of diabetic ketoacidosis at the onset of type 1 diabetes, Diabetes Res Clin Pract, vol.78, issue.2, pp.259-62, 2007.

P. Sundaram, E. Day, and J. Kirk, Delayed diagnosis in type 1 diabetes mellitus, Arch Dis Child, vol.94, issue.2, pp.151-153, 2009.

J. A. Usher-smith, M. J. Thompson, S. J. Sharp, and F. M. Walter, Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults : a systematic review, BMJ, vol.343, p.4092, 2011.

A. Szypowska and A. Skórka, The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus, Pediatr Diabetes, vol.12, pp.302-308, 2011.

O. L. Vries-l-de, L. Lazar, Y. Lebenthal, S. Shalitin, and M. Phillip, Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents, Diabet Med, vol.30, issue.11, pp.1360-1366, 2013.

H. J. Lee, H. W. Yu, H. W. Jung, Y. A. Lee, J. H. Kim et al., Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents, J Korean Med Sci, vol.32, issue.2, p.303, 2017.

J. I. Wolfsdorf, N. Glaser, M. Agus, M. Fritsch, R. Hanas et al., Diabetic ketoacidosis and the hyperglycemic hyperosmolar state, Clinical Practice Consensus, vol.19, issue.S27, pp.155-77, 2018.

J. Wolfsdorf, N. Glaser, and M. A. Sperling, Diabetic Ketoacidosis in Infants, Children, and Adolescents : A consensus statement from the American Diabetes Association, Diabetes Care, vol.29, issue.5, pp.1150-1159, 2006.

L. Caen and . Mer, Les chiffres clés

M. Paw?owicz, D. Birkholz, M. Nied?wiecki, and A. Balcerska, Difficulties or mistakes in diagnosing type 1 diabetes in children ? -demographic factors influencing delayed diagnosis, Pediatr Diabetes, vol.10, issue.8, pp.542-551, 2009.

E. R. Gunn, B. B. Albert, P. L. Hofman, W. S. Cutfield, A. J. Gunn et al., Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes : Evidence from a regional pediatric diabetes center, Pediatr Diabetes, vol.18, issue.7, pp.553-561, 2010.

V. V. Sadauskait-kuehne, U. Samuelsson, E. Ja?inskiene, ?. Padaiga, B. Urbonaite et al., Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition, Diabetes Res Clin Pract, vol.55, issue.3, pp.247-54, 2002.

A. K. Maniatis, S. H. Goehrig, D. Gao, A. Rewers, P. Walravens et al., Increased incidence and severity of diabetic ketoacidosis among uninsured children with newly diagnosed type 1 diabetes mellitus, Pediatr Diabetes, vol.6, issue.2, pp.79-83, 2005.

J. A. Usher-smith, M. J. Thompson, and F. M. Walter, Looking for the needle in the haystack' : a qualitative study of the pathway to diagnosis of type 1 diabetes in children, BMJ Open, vol.3, p.4068, 2013.

J. H. Pinkney, P. J. Bingley, P. A. Sawtell, D. B. Dunger, and E. Gale, The Bart's-Oxford Study Group. Presentation and progress of childhood diabetes mellitus : a prospective population-based study, Diabetologia, vol.37, issue.1, pp.70-74, 1994.

J. Komulainen, R. Lounamaa, M. Knip, E. A. Kaprio, and H. K. Akerblom, Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group, Arch Dis Child, vol.75, issue.5, pp.410-415, 1996.

D. W. Foster and J. D. Mcgarry, The Metabolic Derangements and Treatment of Diabetic Ketoacidosis, N Engl J Med, vol.309, issue.3, pp.159-69, 1983.

A. E. Kitabchi, G. E. Umpierrez, M. B. Murphy, and R. A. Kreisberg, Hyperglycemic Crises in Adult Patients With Diabetes : A consensus statement from the American Diabetes Association, Diabetes Care, vol.29, issue.12, pp.2739-2787, 2006.

M. V. Svart, N. Rittig, U. Kampmann, T. S. Voss, N. Møller et al., Metabolic effects of insulin in a human model of ketoacidosis combining exposure to lipopolysaccharide and insulin deficiency : a randomised, controlled, crossover study in individuals with type 1 diabetes, Diabetologia, vol.60, issue.7, pp.1197-206, 2017.

R. A. Rizza, L. J. Mandarino, and J. E. Gerich, Cortisol-Induced Insulin Resistance in Man : Impaired Suppression of Glucose Production and Stimulation of Glucose Utilization due to a Postreceptor Defect of Insulin Action, J Clin Endocrinol Metab, vol.54, issue.1, pp.131-139, 1982.

H. C. Horner, A. Munck, and G. E. Lienhard, Dexamethasone causes translocation of glucose transporters from the plasma membrane to an intracellular site in human fibroblasts, J Biol Chem, vol.262, issue.36, pp.17696-702, 1987.

A. Ogawa, J. H. Johnson, M. Ohneda, C. T. Mcallister, L. Inman et al., Roles of insulin resistance and beta-cell dysfunction in dexamethasone-induced diabetes, J Clin Invest, vol.90, issue.2, pp.497-504, 1992.

L. Plat, M. M. Byrne, J. Sturis, K. S. Polonsky, J. Mockel et al., Effects of morning cortisol elevation on insulin secretion and glucose regulation in humans, Am J Physiol-Endocrinol Metab, vol.270, issue.1, pp.36-42, 1996.

H. E. Wasmuth, G. Hess, C. Viergutz, H. R. Henrichs, S. Martin et al., Non-specific viral infections as possible synchronising events of the manifestation of Type 1 diabetes, Diabetes Metab Res Rev, vol.16, issue.3, pp.177-185, 2000.

Z. Yang, F. Zhou, J. Dorman, H. Wang, X. Zu et al., Association between infectious diseases and type 1 diabetes : a case-crossover study, Pediatr Diabetes, vol.7, issue.3, pp.146-52, 2006.

D. V. Serreze, E. W. Ottendorfer, T. M. Ellis, C. J. Gauntt, and M. A. Atkinson, Acceleration of type 1 diabetes by a coxsackievirus infection requires a preexisting critical mass of autoreactive T-cells in pancreatic islets, Diabetes, vol.49, issue.5, pp.708-719, 2000.

A. Petzold, M. Solimena, and K. Knoch, Mechanisms of Beta Cell Dysfunction Associated With Viral Infection, Curr Diab Rep, vol.15, issue.10, p.73, 2015.

C. A. Longano and H. P. Fletcher, Insulin release after acute hydrocortisone treatment in mice, Metabolism, vol.32, issue.6, pp.603-611, 1983.

C. Lambillotte, P. Gilon, and J. C. Henquin, Direct glucocorticoid inhibition of insulin secretion. An in vitro study of dexamethasone effects in mouse islets, J Clin Invest, vol.99, issue.3, pp.414-437, 1997.

G. Vila, M. Krebs, M. Riedl, S. M. Baumgartner-parzer, M. Clodi et al., Acute effects of hydrocortisone on the metabolic response to a glucose load : increase in the first-phase insulin secretion, Eur J Endocrinol, vol.163, issue.2, pp.225-256, 2010.

M. Dorey, A. Boileau, O. Pourrat, R. Maréchaud, and F. Pierre, Décompensation cétosique d'un diabète maternel au décours d'une corticothérapie de maturation pulmonaire foetale. À propos de trois cas, J Gynécologie Obstétrique Biol Reprod, vol.43, issue.8, pp.633-639, 2014.

E. Böber, ?. Dündar, and ?. Büyükgebiz, Partial Remission Phase and Metabolic Control in Type 1 Diabetes Mellitus in Children and Adolescents, J Pediatr Endocrinol Metab, vol.14, issue.4, pp.435-442, 2001.

Y. Xin, M. Yang, X. J. Chen, Y. J. Tong, and L. H. Zhang, Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China. J Paediatr Child Health, vol.46, issue.4, pp.171-176, 2010.

S. C. Manson, R. E. Brown, A. Cerulli, and C. F. Vidaurre, The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use, Respir Med, vol.103, issue.7, pp.975-94, 2009.

K. Ould-ouali, Evaluation du parcours de soin des enfants et adolescents avant la découverte d'un diabète de type 1 : étude observationnelle au CHU de Reims, 2018.

J. Karjalainen, P. Salmela, J. Ilonen, H. Surcel, and M. Knip, A Comparison of Childhood and Adult Type I Diabetes Mellitus, N Engl J Med, vol.320, issue.14, pp.881-887, 1989.

, Diagnosis and Classification of Diabetes Mellitus, Diabetes Care, vol.33, issue.S1, pp.62-71, 2010.

R. Mori, N. Yonemoto, A. Fitzgerald, K. Tullus, K. Verrier-jones et al., Diagnostic performance of urine dipstick testing in children with suspected UTI : a systematic review of relationship with age and comparison with microscopy, Acta Paediatr, vol.99, issue.4, pp.581-585, 2010.

A. D. Hay, K. Birnie, J. Busby, B. Delaney, H. Downing et al., The Diagnosis of Urinary Tract infection in Young children (DUTY) : a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness, Health Technol Assess, vol.20, issue.51, pp.1-294, 2016.

A. Bataille, M. Wetzstein, A. Hertig, S. Vimont, E. Rondeau et al., Evidence of dipstick superiority over urine microscopy analysis for detection of hematuria, BMC Res Notes, vol.9, issue.1, p.80, 2016.
URL : https://hal.archives-ouvertes.fr/hal-01366724

A. G. Marques, A. M. Doi, J. Pasternak, S. Damascena-m-dos, C. N. França et al., Performance of the dipstick screening test as a predictor of negative urine culture, Einstein, vol.15, issue.1, pp.34-43, 2017.

W. Hollingworth, J. Busby, C. C. Butler, K. O'brien, J. Sterne et al., The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule : Economic Evaluation. Value Health, vol.20, pp.556-66, 2017.

J. Girard, Rôle des reins dans l'homéostasie du glucose. Implication du cotransporteur sodium-glucose SGLT2 dans le traitement du diabète, Néphrologie Thérapeutique, vol.13, issue.S1, pp.35-41, 2017.

C. Piffaretti, L. Mandereau-bruno, S. Guilmin-crepon, C. Choleau, R. Coutant et al., Trends in childhood type 1 diabetes incidence in France, 2010.

C. Ccam--facturer-en,

J. Komulainen, P. Kulmala, K. Savola, R. Lounamaa, J. Ilonen et al., Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group, Diabetes Care, vol.22, issue.12, pp.1950-1955, 1999.

A. Hekkala, M. Knip, and R. Veijola, Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in Northern Finland : Temporal changes over 20 years, Diabetes Care, vol.30, issue.4, pp.861-867, 2007.

R. Nimri, M. Phillip, and S. Shalitin, Children Diagnosed with Diabetes during Infancy Have Unique Clinical Characteristics, Horm Res Paediatr, vol.67, issue.6, pp.263-270, 2007.

M. Abdul-rasoul, A. , M. Al-qattan, H. , A. et al., Ketoacidosis at presentation of type 1 diabetes in children in Kuwait : frequency and clinical characteristics, Pediatr Diabetes, vol.11, issue.5, pp.351-357, 2010.

C. Jefferies, S. W. Cutfield, J. Derraik, J. Bhagvandas, B. B. Albert et al., 15-year incidence of diabetic ketoacidosis at onset of type 1 diabetes in children from a regional setting, Sci Rep, vol.5, p.10358, 2015.

S. A. Bowden, M. M. Duck, and R. P. Hoffman, Young children (<5 yr) and adolescents (>12 yr) with type 1 diabetes mellitus have low rate of partial remission : Diabetic ketoacidosis is an important risk factor, Pediatr Diabetes, vol.9, pp.197-201, 2008.

A. N. Jeffery, B. S. Metcalf, J. Hosking, A. J. Streeter, L. D. Voss et al., Age Before Stage : Insulin Resistance Rises Before the Onset of Puberty : A 9-year longitudinal study (EarlyBird 26), Diabetes Care, vol.35, issue.3, p.81, 2012.

S. Fredheim, J. Johannesen, A. Johansen, L. Lyngsøe, H. Rida et al., Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels, Diabetologia, vol.56, issue.5, pp.995-1003, 2013.

M. Quinn, A. Fleischman, B. Rosner, D. J. Nigrin, and J. I. Wolfsdorf, Characteristics at diagnosis of type 1 diabetes in children younger than 6 years, J Pediatr, vol.148, issue.3, pp.366-71, 2006.

J. Rosenbauer, A. Icks, and G. Giani, Clinical Characteristics and Predictors of Severe Ketoacidosis at Onset of Type 1 Diabetes Mellitus in Children in a North Rhine-Westphalian Region, J Pediatr Endocrinol Metab, vol.15, issue.8, pp.1137-1146, 2011.

J. A. Edge, M. M. Hawkins, D. L. Winter, and D. B. Dunger, The risk and outcome of cerebral oedema developing during diabetic ketoacidosis, Arch Dis Child, vol.85, issue.1, pp.16-22, 2001.

D. B. Dunger, M. A. Sperling, C. L. Acerini, D. J. Bohn, D. Daneman et al., ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents, Arch Dis Child, vol.89, issue.2, pp.188-94, 2004.

M. Abdul-rasoul, H. Habib, A. , and M. , The honeymoon phase' in children with type 1 diabetes mellitus : frequency, duration, and influential factors, Pediatr Diabetes, vol.7, issue.2, pp.101-108, 2006.

M. Fernandez-castañer, E. Montaña, I. Camps, J. Biarnes, J. F. Merino et al., Ketoacidosis at diagnosis is predictive of lower residual beta-cell function and poor metabolic control in type 1 diabetes, Diabetes Metab, vol.22, issue.5, pp.349-55, 1996.

F. Castañer, M. Gonzálbez, J. Carrera, M. J. Nacher, V. Montanya et al., The influence of clinical presentation and metabolic control of insulin dependent diabetes in the evolution of residual insulin secretion. A prospective study at five years, Med Clin, vol.109, issue.9, pp.328-360, 1997.

L. M. Duca, B. Wang, M. Rewers, and A. Rewers, Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control, Diabetes Care, vol.40, issue.9, pp.1249-55, 2017.

G. J. Biessels, I. J. Deary, and C. M. Ryan, Cognition and diabetes : a lifespan perspective, Lancet Neurol, vol.7, issue.2, pp.184-90, 2008.

J. M. Naguib, E. Kulinskaya, C. L. Lomax, and M. E. Garralda, Neuro-cognitive Performance in Children with Type 1 Diabetes-A Meta-analysis, J Pediatr Psychol, vol.34, issue.3, pp.271-82, 2009.

S. Ghetti, J. K. Lee, C. E. Sims, D. M. Demaster, and N. S. Glaser, Diabetic Ketoacidosis and Memory Dysfunction in Children with Type 1 Diabetes, J Pediatr, vol.156, issue.1, pp.109-123, 2010.

T. Wysocki, M. A. Harris, N. Mauras, L. Fox, A. Taylor et al., Absence of Adverse Effects of Severe Hypoglycemia on Cognitive Function in School-Aged Children With Diabetes Over 18 Months, Diabetes Care, vol.26, issue.4, pp.1100-1105, 2003.

S. K. Strudwick, C. Carne, J. Gardiner, J. K. Foster, E. A. Davis et al., Cognitive Functioning in Children with Early Onset Type 1 Diabetes and Severe Hypoglycemia, J Pediatr, vol.147, issue.5, pp.680-685, 2005.

S. L. Wootton-gorges, M. H. Buonocore, N. Kuppermann, J. P. Marcin, P. D. Barnes et al., Cerebral Proton Magnetic Resonance Spectroscopy in Children with Diabetic Ketoacidosis, Am J Neuroradiol, vol.28, issue.5, pp.895-904, 2007.

F. J. Cameron, S. E. Scratch, C. Nadebaum, E. A. Northam, I. Koves et al., Neurological Consequences of Diabetic Ketoacidosis at Initial Presentation of Type 1 Diabetes in a Prospective Cohort Study of Children, Diabetes Care, vol.37, issue.6, pp.1554-62, 2014.

J. J. Couper, M. J. Haller, C. J. Greenbaum, A. Ziegler, D. K. Wherrett et al., Stages of type 1 diabetes in children and adolescents, Clinical Practice Consensus, vol.19, issue.S27, pp.20-27, 2018.

A. P. Lambert, K. M. Gillespie, G. Thomson, H. J. Cordell, J. A. Todd et al., Absolute Risk of Childhood-Onset Type 1 Diabetes Defined by Human Leukocyte Antigen Class II Genotype : A Population-Based Study in the United Kingdom, J Clin Endocrinol Metab, vol.89, issue.8, pp.4037-4080, 2004.

H. Erlich, A. M. Valdes, J. Noble, J. A. Carlson, M. Varney et al., HLA DR-DQ Haplotypes and Genotypes and Type 1 Diabetes Risk : Analysis of the Type 1 Diabetes Genetics Consortium Families, Diabetes, vol.57, issue.4, pp.1084-92, 2008.

M. Marigliano, A. Morandi, M. Maschio, S. Costantini, G. Contreas et al., Diabetic ketoacidosis at diagnosis : role of family history and class II HLA genotypes, Eur J Endocrinol, vol.168, issue.1, pp.107-118, 2013.

A. G. Ziegler, M. Rewers, O. Simell, T. Simell, J. Lempainen et al., Seroconversion to Multiple Islet Autoantibodies and Risk of Progression to Diabetes in Children, JAMA, vol.309, issue.23, pp.2473-2482, 2013.

M. Zamaklar, A. Jotic, N. Lalic, K. Lalic, N. Rajkovic et al., Relation between Course of Disease in Type 1 Diabetes and Islet Cell Antibodies, Ann NY Acad Sci, vol.958, issue.1, pp.251-254, 2002.

H. E. Larsson, K. Vehik, R. Bell, D. Dabelea, L. Dolan et al., Reduced Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Young Children Participating in Longitudinal Follow-Up, Diabetes Care, vol.34, issue.11, pp.2347-52, 2011.

C. Winkler, E. Schober, A. Ziegler, and R. W. Holl, Markedly reduced rate of diabetic ketoacidosis at onset of type 1 diabetes in relatives screened for islet autoantibodies, Pediatr Diabetes, vol.13, issue.4, pp.308-321, 2012.

A. K. Steck, H. E. Larsson, X. Liu, R. Veijola, J. Toppari et al., Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls, Pediatr Diabetes, vol.18, issue.8, pp.794-802, 2017.

J. Raab, F. Haupt, M. Scholz, C. Matzke, K. Warncke et al., Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population : design and initial results of the Fr1da study, BMJ Open, vol.6, p.11144, 2016.

C. Meehan, B. Fout, J. Ashcraft, D. A. Schatz, and M. J. Haller, Screening for T1D risk to reduce DKA is not economically viable, Pediatr Diabetes, vol.16, issue.8, pp.565-72, 2015.

B. Calderon and D. B. Sacks, Islet Autoantibodies and Type 1 Diabetes : Does the Evidence Support Screening ?, Clin Chem, vol.60, issue.3, pp.438-478, 2014.

C. A. Beam, C. Maccallum, K. C. Herold, D. K. Wherrett, J. Palmer et al., GAD vaccine reduces insulin loss in recently diagnosed type 1 diabetes : findings from a Bayesian meta-analysis, Diabetologia, vol.60, issue.1, pp.43-52, 2017.

M. J. Haller, D. A. Schatz, J. S. Skyler, J. P. Krischer, B. N. Bundy et al., Low-Dose Anti-Thymocyte Globulin (ATG) Preserves ?-Cell Function and Improves HbA1c in New-Onset Type 1 Diabetes, Diabetes Care, vol.41, issue.9, pp.1917-1942, 2018.

, Brochure envoyée aux médecins généralistes inclus dans l'étude « Par délibération de son Conseil en date du 10 Novembre 1972, l'Université n'entend donner aucune approbation ni improbation aux opinions émises dans les thèses ou mémoires, Annexe, vol.3

, Ces opinions doivent être considérées comme propres à leurs auteurs

L. Vu, V. U. Président-de-thèse, and V. U. Le-doyen-de-l&apos;ufr-santé,

A. Le-doyen-de-l&apos;ufr-de-santé and . De-soutenance, , p.2019

N. Thomas,

T. De, L. A. Thèse, and . Français, Facteurs favorisant l'acidocétose diabétique inaugurale lors du diagnostic de diabète de type 1 chez l'enfant : Etude rétrospective et évaluation des pratiques des médecins généralistes de l'agglomération Caennaise

R. De, L. A. Thèse, and . Français, Objectifs : Evaluer les facteurs liés à l'acidocétose diabétique (ACD) inaugurale lors du diagnostic de diabète de type 1 (DT1) chez l'enfant

M. Matériel, Un questionnaire évaluant les obstacles liés au diagnostic de DT1 de l'enfant a été envoyé aux médecins généralistes (MG) de « Caen La Mer » en août 2018. Résultats : L'étude a inclus 132 enfants. La prévalence de l'ACD était de 40,2% avec 15,2% pour les formes sévères. L'ACD, sévère ou non, était associée à l'absence de profession des parents (p<0,05), à la réalisation du diagnostic aux urgences pédiatriques (UP) (p<0,0001) et à l'existence d'une consultation avant le diagnostic aux UP (p<0,05). La corticothérapie était liée à l'ACD sévère (OR = 4,42 ; p = 0,023) sans lien avec sa fréquence. Une profession intermédiaire (p<0,05) et la biologie au laboratoire (p<0,0001) étaient inversement liées à l'ACD. Le questionnaire a été rempli par 26,8% des MG. Une large proportion différait le diagnostic de DT1 par la réalisation d'une biologie préalable, le manque d'expérience et la confusion faite avec le diabète de type 2. Une difficulté était notée pour près de 3 quarts des MG, par manque de matériel et d'expérience. Conclusion : Une corticothérapie inadaptée, Une étude observationnelle rétrospective a comparé les patients de moins de 16 ans déclarant un DT1 entre 2009 et 2018 au CHU de Caen selon la sévérité de l'ACD. L'âge, la profession des parents, l'histoire familiale de DT1, une corticothérapie inadaptée, les paramètres diagnostiques et clinico-biologiques ont été étudiés

. Mots-clés, Diabète de type 1 ; Acidocétose diabétique ; Corticothérapie

T. Pédiatrie and . Anglais, Factors Supporting Inaugural Diabetic Ketoacidosis in the Diagnosis of Childhood Type 1 Diabetes : Retrospective study and practice evaluation of general practitioners in the agglomeration of Caen

R. De, L. A. Thèse, and . Anglais, Corticosteroids was associated with severe DKA (OR = 4,42; p = 0,023) unrelated to the frequency of the DKA. An intermediate profession (p<0,05) and blood sample in the laboratory (p<0,0001) were inversely related to the DKA. The questionnaire was completed by 26,8% of GP. A large part differs diagnosed T1D by achieving prior blood sampling in laboratory, inexperience and confusion with type 2 diabetes. One difficulty is noted for nearly 3 quarters of GP, mainly for lack of equipment and experience, Aims: To evaluate factors related to inaugural diabetic ketoacidosis (DKA) in type 1 diabetes (T1D) diagnosed in children. Material and Methods: A retrospective observational study compared patients under 16 reporting T1D between, 2009.

. Key-words, Type 1 Diabetes Mellitus; Diabetic Ketoacidosis; Corticosteroid Therapy; Pediatrics