Children with type 1 diabetes in Sweden are still too often diagnosed only when they are already seriously ill, according to new data from the National Diabetes Register. Around 27 percent of affected children are first identified when they have developed diabetic ketoacidosis (DKA), a life-threatening complication, and among those under the age of two the proportion rises to more than half.
Late diagnosis of children with type 1 diabetes in Sweden
Type 1 diabetes is an autoimmune disease in which the body’s immune system destroys the insulin-producing cells in the pancreas. Without insulin, blood glucose levels rise and, over time, this can lead to serious complications affecting the eyes, kidneys, nerves and cardiovascular system. In the short term, however, the most acute danger is diabetic ketoacidosis, where a severe lack of insulin causes the blood to become acidic.
The new figures show that a significant minority of Swedish children are only diagnosed when DKA has already developed. In total, about 27 percent of children with newly diagnosed type 1 diabetes are only detected at this late and dangerous stage, and among children under two years of age the share is around 55 percent. For many of these youngest patients, the first diagnosis comes in hospital, sometimes in intensive care.
Specialists describe DKA as a condition that can develop quickly and require urgent treatment with fluids, insulin and close monitoring. At the same time, they stress that such emergencies are often avoidable if elevated blood sugar is detected earlier in the course of the disease. A simple and inexpensive capillary glucose test or urine test in primary care or emergency departments can usually confirm whether diabetes should be suspected.
Subtle symptoms that hide serious disease in toddlers
Type 1 diabetes develops gradually, and the early signs can be non-specific, especially in very young children. Increased thirst, frequent urination, unusual tiredness and weight loss are among the classic symptoms. Some children also experience stomach pain, nausea or vomiting, which can easily be mistaken for common viral infections.
In infants and toddlers the picture can be even more difficult to interpret. Heavier diapers than usual, frequent night-time urination or children who had stopped wetting the bed starting to do so again can be warning signs of high blood sugar. Irritability and reduced appetite may appear before more obvious symptoms. Pediatricians emphasise that these signals can be easy to miss in everyday life, both for parents and for healthcare staff who see many children with mild infections.
Because of this, doctors underline the importance of including type 1 diabetes in the differential diagnosis when children present with these combinations of symptoms. Even when weight loss is modest or parents are unsure how long the symptoms have been present, checking blood glucose is a quick and low-cost measure. The current pattern of late diagnoses suggests that this does not always happen, particularly for the youngest children.
Parents and healthcare teams call for earlier testing
The rise in late diagnoses has prompted concern from the Swedish Childhood Diabetes Foundation and from clinicians who work with children and adolescents. In connection with World Diabetes Day on 14 November, patient organisations have highlighted the data on DKA at diagnosis to argue for better awareness among both professionals and the public.
For healthcare providers, the discussion focuses on routines in primary care, emergency departments and child health centres. Some experts argue that clinical guidelines should more clearly encourage blood glucose testing when children show combinations of thirst, frequent urination, weight loss and unexplained fatigue, even if they do not appear seriously ill. Others point to the need for continuous training and updated information for general practitioners, nurses and school health services.
Parents’ groups, for their part, stress the emotional and practical consequences of a late diagnosis. An emergency hospital admission with DKA is often traumatic for families and can mean that one parent must suddenly take long periods off work. There is also evidence that experiencing DKA at onset can affect long-term blood sugar control, adding to the burden of managing a chronic disease that already requires daily monitoring and insulin therapy.
A parallel rise of type 2 diabetes among young adults
While the incidence of type 1 diabetes in children has been relatively stable in Sweden in recent years, there is a marked increase in type 2 diabetes among young adults. A recent report from Diabetes Sweden and Diabetes Stockholm indicates that among people aged 19 to 39, the number of individuals living with type 2 diabetes has risen by about 35 percent between 2020 and 2024.
Type 2 diabetes is characterised by insulin resistance, where the body’s cells no longer respond effectively to insulin, and by a gradual decline in insulin production. It is strongly associated with lifestyle factors such as diet, physical inactivity and obesity, although heredity and social conditions also play an important role. In Sweden, researchers have documented a doubling of early-onset type 2 diabetes over the past two decades, with higher rates among people with lower levels of education and among those born outside Europe.
Clinicians warn that Sweden is moving towards a more “Americanised” pattern of disease, with a population that is gaining weight and moving less. They argue that this trend increases the risk not only of type 2 diabetes but also of related conditions such as hypertension and cardiovascular disease. Public health experts therefore call for broader preventive measures, including healthier food environments, restrictions on marketing sugary drinks to children and stronger support for daily physical activity in schools.
From Sweden to Europe: lessons for child health systems
The Swedish figures on late diagnosis of children with type 1 diabetes mirror a challenge seen across the Nordic region and the wider EU. International comparisons have repeatedly shown that Sweden and Denmark belong to the European countries with the lowest average prevalence of diabetic ketoacidosis at diagnosis, yet recent registry data now indicate that around one in four Swedish children still present with DKA – and more than half of those under two years of age – when their disease is first detected.
In Denmark and Norway, national and regional studies also report that roughly 15–25 percent of children are in DKA at the time of diagnosis, with the highest risk among the youngest age groups. In a multinational analysis of very young children, almost half of all patients under the age of two across several European centres – including Nordic clinics – presented with some degree of DKA at onset. In Finland, long-term data from northern regions show that about a third of children aged five and under have DKA when type 1 diabetes is first diagnosed, despite strong primary care and high public awareness. Smaller patient numbers in Iceland make trends harder to interpret, but paediatric endocrinologists there report similar concerns about very young children arriving late in the course of the disease.
Across the European Union, researchers describe a wide variation between countries. Large multicountry cohorts have found that, on average, around 25–30 percent of children with newly diagnosed type 1 diabetes in Europe present with DKA, with the lowest prevalence in Northern Europe and the highest in parts of Southern and Western Europe.
More than 59,000 children from 13 high‑income countries, adjusted DKA prevalence at diagnosis reached nearly 30 percent, with Sweden and Denmark at the lower end of the spectrum and countries such as Italy and Luxembourg reporting rates close to or above 40 percent. The first year of the COVID‑19 pandemic further increased the share of children presenting in DKA in many European health systems, as families delayed seeking care and services were under pressure.
For policymakers in the Nordic countries and in the EU institutions, these patterns underline the need to strengthen early detection strategies for chronic conditions in children. In the case of type 1 diabetes, this includes awareness campaigns aimed at parents and schools, clinical guidelines that lower the threshold for blood glucose testing in symptomatic children and, in the longer term, discussion of targeted screening programmes for high‑risk groups, in line with recent recommendations from international paediatric diabetes societies.
At the same time, the sharp rise in early‑onset type 2 diabetes among young adults in Sweden and other European countries shows that prevention must also address the social and environmental determinants of health – from food environments to opportunities for daily physical activity.
The combination of late diagnosis in young children and rising type 2 diabetes in younger adults therefore represents a double challenge for Nordic and EU health systems. How Sweden and its neighbours respond – through primary care, public health policy and cooperation between healthcare providers, schools and families – will be watched closely in other European contexts. If more children can be diagnosed before they develop DKA, and if fewer young adults develop type 2 diabetes, the long‑term benefits for both individuals and the healthcare system could be substantial.
