Delayed diagnosis of type 1 diabetes in children-still a significant issue?.

Abstract

Introduction: Same day referral (SDR) for specialist management of suspected type 1 diabetes (T1DM) is widely recommended to minimise rates of diabetic ketoacidosis (DKA) and its associated mortality, morbidity and neurocognitive sequelae. Objective(s): The aims of this study were to determine the number of individuals who had attended a general medical professional (GP) prior to presentation for specialist management, to establish the frequency of appropriate SDR practice and the effect of current practice on clinical outcomes. Method(s): Individuals aged <=18 years diagnosed with new-onset T1DM at two Melbourne tertiary paediatric hospitals (Royal Children's and Monash Children's Hospital) between July 2015 - July 2016 were identified from departmental databases. Data collected included presentation to a GP within 1 month of diagnosis, whether SDR ensued, the time interval between any initial assessment and presentation for specialist review, pre-referral investigations, presence of DKA, length of hospital stay (LOS) and complexity of required care. Result(s): During the study period 206 individuals (males = 92) aged 12 months to 17 years diagnosed with new-onset T1DM were identified. Of these 154 (75%) were seen by their GP within the preceding 30 days with SDR in 82/154 (53%). Pre-referral phlebotomy was arranged for 42/154 (27%) individuals. DKA was noted in 93/206 (45%) individuals, and rates were higher in those with delayed referrals (DR) compared to SDR [36/93 (39%) vs 34/93 (37%)]. Severity was increased with DR with more severe DKA (8/93 vs 5/93), worse complications, longer PICU admissions and a difference in LOS compared to SDR (3.7 vs 3.5 days). Conclusion(s): The high rates of DKA at presentation and delayed referral indicate a low level of awareness of the symptoms of T1DM and potential risks associated with the delay by GPs. This lends support for a health campaign to improve early diagnosis rates of T1DM.