Given these symptoms are so specific it’s important that these children access their GP in good time because they do a good job of making the diagnosis.
- Dr Joseph Lee, University of Oxford
Opportunities including improved access to primary care and public awareness of the condition could facilitate a faster diagnosis, the research concluded.
In the UK, most unwell children are seen in primary care, but little is known about how these children interact with primary care in the weeks leading up to diagnosis of type 1 diabetes.
The epidemiology of type 1 diabetes suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis – a complication where the body starts running out of insulin.
In response, a research team led by Oxford University’s Nuffield Department of Primary Care Health Sciences with the Universities of Cambridge and Washington studied routinely collected UK primary care patient records to explore opportunities for earlier diagnosis of type 1 diabetes in children outside of hospital.
The data included 1920 new cases of type 1 diabetes in children aged 0-16, which were compared 7680 records of children who did not receive a diabetes diagnosis. In their analysis of the data, the researchers looked for evidence of the typical “red flag” symptoms of type 1 diabetes in the 13 weeks before diagnosis, and the types of consultations recorded.
In the week prior to diagnosis they found that more new cases than controls had medical record entries (34.5% versus 13.6%), and they were more likely to have a face-to-face consultation. In the preceding week, entries were found in 17.2% of new cases compared with 12.3% of controls, yet the incidence of face-to-face consultations in both groups was no different.
Lead author Dr Joseph Lee, an Oxfordshire GP and NIHR In Practice Fellow in Oxford University’s Nuffield Department of Primary Care Health Sciences, said GPs should be more aware of the symptoms of diabetic ketoacidosis:
“NICE recommends clinicians be aware of red flag symptoms for type 1 diabetes, yet very few children in our study had a record of these – just 17%. Other studies surveying parents have found a far higher proportion, with at least one symptom described by every parent. While the number of children presenting with diabetic ketoacidosis and type 1 diabetes is relatively small, given these symptoms are so specific it’s important that these children access their GP in good time because they do a good job of making the diagnosis.”
“Further research could focus around the effects of improved public awareness and access to primary care for children with known risk factors for diabetic ketoacidosis.”
Opportunities for earlier diagnosis of type 1 diabetes in children: a case-control study using routinely collected primary care records.
Lee JL, Thomspon MJ, Usher-Smith JA, Koshiaris C, Van den Bruel A
Primary Care Diabetes 2018 doi: 10.1016/j.pcd.2018.02.002