Delayed referral is common even when new-onset diabetes is suspected in children. A Swedish prospective observational study of diabetic ketoacidosis at onset of Type 1 diabetes.
Type 1 diabetes
children
delayed referral
diabetic ketoacidosis
symptoms
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
revised:
04
03
2021
received:
20
01
2021
accepted:
23
04
2021
pubmed:
13
5
2021
medline:
2
2
2022
entrez:
12
5
2021
Statut:
ppublish
Résumé
Delayed treatment for new-onset diabetes Type 1 (T1D) can lead to diabetic ketoacidosis (DKA) with potentially devastating consequences. This prospective observational study aimed to characterize pediatric patients with DKA at hospital admission, regarding parental awareness of diabetes-related symptoms and delayed referrals from primary health care providers to pediatric emergency wards. Patients 0-18 years admitted to hospital with new-onset T1D and DKA between 2015 and 2017 were invited to participate. Questionnaires were filled out separately by the caregivers and by the attending hospital staff. Data from the Swedish National Diabetes Registry (SWEDIABKIDS) were used for comparison. Delayed referral was defined as a primary healthcare contact due to diabetes-related symptoms 0-4 weeks before hospital admission without immediate referral, or registered elevated glucose levels at primary healthcare centers without immediate referral. The study included 237 patients, among which parental suspicion of new-onset diabetes before healthcare contacts was reported in 39%. Parental suspicion of diabetes was associated with higher pH values at diagnosis. Patients in contact with primary health care providers before hospital admission had a delayed referral in 43% of the cases. Delayed referral was associated with lower pH values at hospital admission. Symptoms leading to primary healthcare contacts were similar regardless of whether delay occurred or not. Parental suspicion of diabetes was associated with milder DKA at hospital admission. Delayed referral was seen in a considerable proportion of children with primary healthcare contacts for symptoms associated with diabetes. Increased awareness of diabetes symptoms is of paramount importance.
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
900-908Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. Pediatric Diabetes published by John Wiley & Sons Ltd.
Références
Mayer-Davis EJ, Kahkoska AR, Jefferies C, et al. ISPAD clinical practice consensus guidelines 2018: definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19(Suppl 27):7-19.
Samuelsson USU, Åkesson K, Forsander G, et al. Definition, epidemiology and classification. The Swedish reference Group for National Guidelines. 2017. https://endodiabbarnlakarforeningense/wp-content/uploads/sites/9/2015/03/VP_2017_Kap1-DefEpidem-Klassifpdf
Lansdown AJ, Barton J, Warner J, et al. Prevalence of ketoacidosis at diagnosis of childhood onset type 1 diabetes in Wales from 1991 to 2009 and effect of a publicity campaign. Diabet Med. 2012;29(12):1506-1509.
Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19(Suppl 27):155-177.
Duca LM, Reboussin BA, Pihoker C, et al. Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: the SEARCH for diabetes in youth study. Pediatr Diabetes. 2019;20(2):172-179.
Shalitin S, Fisher S, Yackbovitch-Gavan M, et al. Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control. Pediatr Diabetes. 2018;19(2):320-328.
Cameron FJ, Scratch SE, Nadebaum C, et al. Neurological consequences of diabetic ketoacidosis at initial presentation of type 1 diabetes in a prospective cohort study of children. Diabetes Care. 2014;37(6):1554-1562.
Iyer D, Choudhary D, Agwu JC. Timeliness of referral of children with new onset type 1 diabetes. Postgrad Med J. 2017;93(1099):242-244.
Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care. 1999;22(1):7-9.
Fritsch M, Schober E, Rami-Merhar B, et al. Diabetic ketoacidosis at diagnosis in Austrian children: a population-based analysis, 1989-2011. J Pediatr. 2013;163(5):1484-8 e1.
Charalampopoulos D, Hermann JM, Svensson J, et al. Exploring variation in glycemic control across and within eight high-income countries: a cross-sectional analysis of 64,666 children and adolescents with type 1 diabetes. Diabetes Care. 2018;41(6):1180-1187.
Dudgeon P. Some improvements in confidence intervals for standardized regression coefficients. Psychometrika. 2017;82(4):928-951.
Muir AB, Quisling RG, Yang MC, Rosenbloom AL. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes Care. 2004;27(7):1541-1546.
Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia. 2012;55(11):2878-2894.
Cherubini V, Grimsmann JM, Akesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63(8):1530-1541.
Annual Report of the Swedish National Paediatric Diabetes Registry (SWEDIABKIDS) [Internet]. 2018. https://www.ndr.nu/pdfs/Yearreport_Swediabkids_2018_Eng.pdf
Hanas R, Lindgren F, Lindblad B. Diabetic ketoacidosis and cerebral oedema in Sweden-a 2-year paediatric population study. Diabet Med. 2007;24(10):1080-1085.
Schoenle EJ, Schoenle D, Molinari L, Largo RH. Impaired intellectual development in children with type I diabetes: association with HbA(1c), age at diagnosis and sex. Diabetologia. 2002;45(1):108-114.
Aye T, Mazaika PK, Mauras N, et al. Impact of early diabetic ketoacidosis on the developing brain. Diabetes Care. 2019;42(3):443-449.
Pawlowicz M, Birkholz D, Niedzwiecki M, Balcerska A. Difficulties or mistakes in diagnosing type 1 diabetes mellitus in children? The consequences of delayed diagnosis. Pediatr Endocrinol Diabetes Metab. 2008;14(1):7-12.
Ucar A, Saka N, Bas F, et al. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care Centre: potential impact of a national programme highlighted. J Pediatr Endocrinol Metab. 2013;26(11-12):1059-1065.
de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M. Factors associated with diabetic ketoacidosis at onset of type 1 diabetes in children and adolescents. Diabet Med. 2013;30(11):1360-1366.
Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ. 2011;343:d4092.
Gunn ER, Albert BB, Hofman PL, et al. Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014. Pediatr Diabetes. 2017;18(7):553-558.
Baldelli L, Flitter B, Pyle L, et al. A survey of youth with new onset type 1 diabetes: opportunities to reduce diabetic ketoacidosis. Pediatr Diabetes. 2017;18(7):547-552.
Lokulo-Sodipe K, Moon RJ, Edge JA, Davies JH. Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK. Arch Dis Child. 2014;99(5):438-442.
Szypowska A, Skorka A. The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes. 2011;12(4 Pt 1):302-306.