Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon? (original) (raw)
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Characteristics of children presenting with newly diagnosed type 1 diabetes
South African Journal of Child Health, 2013
Background. The clinical presentation of type 1 diabetes in children can be acute or insidious, and symptoms may be subtle and frequently misinterpreted. Presentation with diabetic keto-acidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. This study aims to determine the characteristics of children presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central Hospital (IALCH) with DKA at the time of diagnosis, and to determine the frequency of missed diagnoses in the previous month. Methods. A retrospective study was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal, South Africa. The study sample included all children with an initial diagnosis of type 1 diabetes between January 2008 and June 2010. Children presenting with DKA were compared with those who presented without DKA. Results. During the period under review, 63 children presented with type 1 diabetes. Of these, 44 (69.8%) had DKA at the time of diagnosis. The median duration of symptoms preceding diagnosis in the DKA group was 2 weeks, versus 4 weeks in the non-DKA group (p=0.002). There was no significant difference between the groups when ethnicity, gender and age at presentation were compared. Of 42 patients who presented to healthcare facilities in the month preceding diagnosis, 27 (64.3%) were misdiagnosed. Conclusion. Patients who presented with DKA had a shorter duration of symptoms than the non-DKA group. Ethnicity had no effect on characteristics at presentation. There was an unacceptable rate of missed diagnoses of type 1 diabetes in both the private and public sectors.
Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents
Diabetes & Metabolism, 2014
Objectives.-This study aimed to evaluate the frequency of diabetic ketoacidosis (DKA) and its associated factors at the diagnosis of type 1 diabetes (T1D) in French children and adolescents prior to launching a public-health campaign of information to prevent DKA. Patients and methods.-Over a 1-year period, 1299 youngsters (aged < 15 years) were diagnosed with T1D at 146 paediatric centres in all regions of France. Age, gender, duration of symptoms, patient's pathway to diagnosis, clinical and biological signs, and family history of T1D were collected for each newly diagnosed patient. DKA was defined as pH < 7.30 or bicarbonate < 15 mmol/L, and severe DKA as pH < 7.10 or bicarbonate < 5 mmol/L. Results.-At the time of diagnosis, 26% of the children were aged 0-5 years, 34% were 5-10 years and 40% were 10-15 years. The overall prevalence of DKA was 43.9% (0-5 years: 54.2%; 5-10 years: 43.4%; and 10-15 years: 37.1%) and 14.8% for severe DKA (0-5 years: 16.6%; 5-10 years: 14.4%; and 10-15 years: 13.9%; < 2 years: 25.3%). Severe DKA was more frequent when the child was hospitalized at the family's behest (26.6%) than when referred by a general practitioner (7.6%) or paediatrician (5.1%; 30.6%, 53.7% and 9.2%, respectively, by patients' age group). The frequency of DKA decreased to 20.1% (severe DKA: 4.4%) in families with a history of T1D. Multivariate analysis showed that age, pathway to diagnosis, duration of polyuria/polydipsia (< 1 week) and family history of T1D were associated with the presence of DKA, while pathway to diagnosis and family history of T1D were associated with severe DKA. Conclusion.-DKA at the time of T1D diagnosis in children and adolescents is frequent and often severe. Patients' age, pathway to hospitalization and family history of diabetes were the main factors associated with DKA. These data suggest that a public-health campaign to prevent DKA at diagnosis can help reduce the frequency of DKA and also provide baseline data for evaluating the efficacy of such a campaign.
Pediatric Diabetes, 2009
Introduction: Delayed diagnosis is one of the causes of diabetic ketoacidosis (DKA) development in many children with new-onset of type 1 diabetes mellitus (T1DM). The aim of the study was to analyse difficulties in diagnosing T1DM and establish if delayed recognition is the main risk factor of diabetic ketoacidosis (DKA) in children with newly diagnosed T1DM. Materials and methods: Retrospective analysis of 335 children with new-onset T1DM, aged below 17 years and living in the Pomeranian region of Poland, was carried out. The delay in diagnosis was recognized if the patient was not diagnosed on the first visit because of omission, wrong interpretation of symptoms, exclusive treatment of additional diabetic signs or concomitant diseases. Results: Difficulties in diagnosing T1DM were found in 54 cases (16.12%). The initial diagnosis was wrongly categorized as respiratory system infection (46.3%), perineal candidiasis (16.6%), gastroenteritis (16.6%), urinary tract infection (11.1%), stomatitis (11.1%), appendicitis (3.7%). Duration of symptoms (mean 14 days) and glycated haemoglobin level did not significantly correspond with diagnostic delay. DKA was significantly more frequent in children with delayed diagnosis -33 patients (61.11%) (p=0.0005). The infection preceding diagnosis of T1DM, more common among children with delayed recognition, did not affect the duration of symptoms or affect characteristicly more frequent DKA development in children with diagnostic delay. Conclusions: No significant associations between diagnostic delay and duration of diabetic symptoms as well as glycated haemoglobin level exclude possibility of delayed diagnosis because of slow development of diabetic symptoms. Significantly more frequent DKA development in children with delayed recognition, irrespective of infection preceding diagnosis, and no confirmation that younger patient's age predisposes to quick increase of DKA point out that the main risk factor for DKA development in the research group was diagnostic delay.
Clinical presentation of type 1 diabetes
Pediatric Diabetes, 2005
Objective: To identify the presenting features of type 1 diabetes in a national incident cohort aged under 15 yr, the duration of symptoms, the occurrence of diabetic ketoacidosis (DKA) at presentation, and the frequency of a family history of diabetes. Methods: A prospective study was undertaken of incident cases of type 1 diabetes using an active monthly reporting card system from January 1, 1997 to December 31, 1998 in the Republic of Ireland. Follow-up questionnaires were distributed to pediatricians nationally. Results: Two hundred and eighty-three incident cases were identified. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age categories. Nocturnal enuresis was reported in 19% under 5 yr and in 31% aged 5-9.99 yr. Constipation was noted in five patients and in 10.4% under 5 yr of age. The median duration of symptoms was highest in the youngest (under 2 yr) and oldest (10-14.99 yr) age categories. Presentation in moderate/severe DKA occurred in 25% overall and six of nine of those aged under 2 yr. A family history of type 1 diabetes in a first-degree relative was found in 10.2%. Conclusions: This study confirms the abrupt onset of type 1 diabetes, the absence of a family history, and the importance of the classical symptoms of polyuria, polydipsia, and weight loss in the majority of cases. It reveals secondary enuresis as an important symptom, especially in those under 10 yr, and constipation in the under 5 yr age group. The very young (under 2 yr) are more difficult to diagnose, have more variability of symptom duration, and are more likely to present in moderate/severe DKA. A high index of suspicion aids early diagnosis.
Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait
Scientific Reports, 2016
We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0-14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1 st January 2011 and 31 st December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2-14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27-0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait. Diabetic ketoacidosis (DKA) is a serious life threatening complication of type 1 diabetes mellitus (T1DM) and constitutes a medical emergency with significant morbidity and mortality 1 , mostly due to cerebral edema during the course of resuscitation 2,3. Worldwide, approximately 65,000 children aged under 15 years develop T1DM each year, and 13% to 80% of these children present with DKA at the time of diagnosis 4. The highest frequencies for DKA at presentation of T1DM are seen in Saudi Arabia (44.9%) 5 , Taiwan (65%), Romania (67%), and the United Arab Emirates (80%), and the lowest in Hungary (23%), Finland (22%), Canada (18.6%) and Sweden (14%) 4. During the period 1990-1999, the multinational World Health Organization (WHO) sponsored Diabetes Mondiale (DiaMond) Project, has reported worldwide variations in incidence of T1DM in children, by means of using standardized incidence data from 57 countries 4,6. Utilizing the DiaMond protocol on data from Kuwait, during the 1990s, a high incidence of T1DM, was reported from Kuwait 7 , rising from 15.4 to 20.9 per 100000 8 , and nearly half of the children aged 0-14 years presented with DKA 9. Recently, there has been an increasing global interest to assess the incidence rates of DKA 10. However, reports on DKA from Arab countries are scarce and are limited to few studies from Kuwait 9,11 , Saudi Arabia 5,12,13 , Oman 14 and the United Arab Emirates 15. In the present study, we report the incidence and severity of DKA in children who presented with T1DM in 2011-2013 in Kuwait, and explore the trend of frequency of DKA over the last two decades.
Primary care diabetes, 2018
The epidemiology of type 1 diabetes mellitus (T1DM) suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis. We sought to quantify opportunities for earlier diagnosis of T1DM in primary care. A matched case-control study of children (0-16 years) presenting to UK primary care, examining routinely collected primary care consultation types and National Institute for Health and Care Excellence (NICE) warning signs in the 13 weeks before diagnosis. Our primary analysis included 1920 new T1DM cases and 7680 controls. In the week prior to diagnosis more cases than controls had medical record entries (663, 34.5% vs 1014, 13.6%, odds ratio 3.46, 95% CI 3.07-3.89; p<0.0001) and the incidence rate of face-to-face consultations was higher in cases (mean 0.32 vs 0.11, incidence rate ratio 2.90, 2.61-3.21; p<0.0001). The preceding week entries were found in 330 cases and 943 controls (17.2% vs 12.3%, OR 1.49, 1.3-1.7, p<0.0001), but face-to-fac...