Endocrine Abstracts

Background: Late diagnosis of type 1 diabetes mellitus (T1DM) in children can lead to diabetic ketoacidosis (DKA), a potentially life-threatening complication. Early identification and intervention are essential for improved outcomes.

Aims: To identify the key factors contributing to delayed diagnosis and DKA presentation in children diagnosed with T1DM at Bedford Hospital between 2021 and 2024.

Methods: A retrospective audit of 84 children (aged 1–15 years) diagnosed with T1DM was conducted. Demographic data, GP visit patterns, initial symptoms, investigations, family history, and clinical presentation at diagnosis were analyzed.

Results: • 38.1% had no GP visit prior to diagnosis; 53.6% had one G.P visit.

• Only 14.3% underwent both blood and urine testing at GP level.

• 3.3% had G.P visit with symptoms but unfortunately the symptoms were missed, and no investigations done and all of them presented in DKA

• Common presenting symptoms included polyuria (6%), polydipsia (4.8%), and weight loss (3.6%).

• At diagnosis, 63.1% had ketones (>1.5 mmol/l), and 53.6% had pH <7.34.

• HbA1c >120 mmol/mol was observed in 33.3% of cases.

• 44% required IV insulin therapy; 79.8% were hospitalized for 1–3 days.

• 89.3% had no complications; 2.4% required ITU admission.

Conclusion: A significant proportion of children presented with DKA due to missed or delayed diagnosis. Lack of GP visits, minimal investigations, and limited symptom recognition contributed to late identification.

Learning Points:

• Increased GP awareness and early glucose/urine testing are crucial.

• Family education can lead to earlier presentation.

• Standardized pathways for early recognition are needed.

Future Plans:

• Develop local guidelines for prompt testing in symptomatic children.

• Implement educational initiatives for primary care providers.

• Re-audit in 12 months post-intervention to assess impact.