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The reasons underpinning the considerable increase in incidence over the study period are unclear. This may reflect an actual change in the type 1 diabetes incidence in patients <15 yr. Alternatively, it may reflect an earlier age of onset without change in incidence over all ages, so that greater numbers of people are being diagnosed with type 1 diabetes in adolescence rather than in young adulthood. This would be consistent with the ‘accelerator hypothesis’, which suggests that an increasing rate of obesity is a primary driver for an earlier age of diabetes onset [6]. Studies have shown an association between higher BMI and younger age at diagnosis [9], [10], [11], indicating greater adiposity in childhood may hasten the onset of diabetes mellitus. The ‘accelerator hypothesis’ predicts an early onset rather than increased risk [11], and a Swedish study examining type 1 diabetes incidence on a nation-wide cohort 0–34 yr showed a shift in age of onset towards younger ages, rather than an increase in incidence per se across the whole population [20]. Although we cannot rule out a similar phenomenon in Auckland, we did not observe an increase in BMI SDS among children recently diagnosed with type 1 diabetes, or an association between BMI SDS and age at diagnosis. In fact, we observed an actual increase in age at diagnosis which is inconsistent with the ‘accelerator hypothesis’. Thus, our data suggest a true increase in the incidence of type 1 diabetes in the Auckland region, and not changes driven by increasing adiposity.
Lack of insulin results in ketoacidosis. Ketones are acids that develop in the blood and appear in the urine. Ketones could poison the body and this is a warning sign that the diabetes is out of control. Symptoms of diabetes involve nausea, shortness of breath, vomiting, fruity flavor in breath, dry mouth, and high glucose levels. Complications associated with diabetes are retinopathy, neuropathy, nephropathy, heart disease and gangrene. Hypoglycemia or low blood sugar is yet another problem associated with diabetes mellitus. Symptoms include hunger, tremor, seizure, sweating, dizziness, jerks, tingling sensation and pale skin color. Improper management of diabetes causes low blood sugar, which in turn causes hypoglycemic coma. It is a life threatening condition.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Waitemata District Health Board for the development of SMS4BG, and support from the Health Research Council of New Zealand in partnership with the Waitemata District Health Board and Auckland District Health Board, and the New Zealand Ministry of Health for the randomised controlled trial; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
“There have been so many touching moments in the movement to Stop Diabetes since we launched last year,” commented Larry Hausner, CEO, American Diabetes Association. “People have shared courageous stories of facing their diabetes head on, while others have shared their heart-breaking experiences of losing a loved one because of diabetes. The blog is a new way to raise our collective voices and tell people why we need to Stop Diabetes once and for all.”   

The features most frequently used by current app users were blood glucose diaries (87%, 32/37), followed by carbohydrate/meal diaries (38%, 14/37) with 22% (8/37) reporting insulin dose calculation devices to be useful (Table 3). Table 3 demonstrates the features app users found useful in their current apps. App users reported the most desired feature for future use in an app was an insulin dose calculator (46%, 17/37; Table 4). Table 5 shows that non-app users reported insulin dose calculators to be the third most desired feature (54.6%, n=83/152). Blood glucose diaries were the most desired app feature amongst non-app users (64.4%, 98/152; Table 5). Non app users with T1DM were more likely to desire an insulin dose calculation device, than non-app users with T2DM, P=.01).
The message delivery was managed by our content management system, with messages sent and received through a gateway company to allow for participants to be registered with any mobile network. Sending and receiving messages was free for participants. The system maintained logs of all outgoing and incoming messages. Further details of the intervention can be seen in the published pilot study,28 and protocol.30
The survey was piloted with the first 30 patients with an email addresses (chronological order of clinic visits). Responses were reviewed after response rate reached 50%. As 4 questions were unanswered by some participants, a “none of the above” option was added. The invitations were sent out to the remaining 540 participants. A further 31 participants were excluded (4 email address errors, 13 gestational diabetes, 10 deceased, 4 did not have diabetes) resulting in a final total of 539 participants. This survey remained open for 3 weeks, with reminders sent to non-responders at one week and two weeks.
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