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Papers in which it was unclear whether the inclusion criteria were met were assessed by a third researcher (MJT or FMW), and where either the definition of diabetic ketoacidosis was not given or we were unable to interpret the data presented adequately we contacted the authors for clarification.Quality assessment was conducted independently by at least two reviewers (JAUS and FMW or MJT).
One paper compared the severity of type 1 diabetes at presentation in south east Sweden and Lithuania and so is reported as two studies.18 The analysis is therefore based on 46 studies.When studies recruited children over more than one time period and it was possible to separate all the data into different time periods, we used only the most recent period.
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