Introduction: The incidence of type 1 diabetes (T1DM) is increasing, affecting approximately 1 in 500 children and young people (CYP) under 19 years of age. The diagnosis of diabetes, as well as initial investigations and management is standardised, based on national guidance. Initial education and management have huge importance for long-term glycaemic control. We review the practice in our hospital, to establish our compliance and any deviations from the guidelines. We also look at whether there were any opportunities for earlier diagnosis and to reduce the incidence of newly diagnosed CYP presenting in diabetic ketoacidosis (DKA).
Methods: Retrospective analysis of clinical notes, discharge letters and lab reports.
Results: Over 12 months (October 2017-September 2018) there were 29 CYP newly diagnosed with T1DM in <19-year olds. Time to presentation from onset of symptoms varied from 3 days to 2 months. Polyuria and polydipsia were the commonest symptoms, with weight loss in a third. 4 CYP presented to healthcare professionals over the previous 12 weeks with similar symptoms. 3 of the 4 later presented in DKA. In total 12 CYP presented in DKA, 2 with severe and 10 with mild/moderate DKA. Length of stay varied from 0 to 4 days. 79% were positive for IA2 or GAD autoantibodies or both. 1 CYP was positive for TPO antibodies and 1 CYP was positive for anti-TTg antibodies at diagnosis. 93% received education from the specialist diabetic team prior to discharge, the rest from nursing and medical staff. Approximately 38% of CYP were carbohydrate counting at discharge.
Conclusions: These data demonstrate that there was a wide range of time between onset of symptoms and diagnosis. There was a missed opportunity for an earlier diagnosis in 4/29 CYP, 3 of whom later presented in DKA, highlighting the importance of ongoing education and awareness in primary care and the general public, to facilitate prompt diagnosis. We will continue to campaign for increased awareness of the symptoms of new onset of diabetes through participating in education sessions. We always feedback to colleagues in primary care for delayed diagnoses. This approach is important to be considered at regional and national level.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes