Endocrine Abstracts

Background: Unrecognised type I diabetes (TIDM) can have serious consequences which may be avoidable with early diagnosis. Many children have delayed diagnosis, however contributing factors are unclear.

Aims: To evaluate the patient pathway before diagnosis and initial hospital management of children with TIDM.

Methods: Over a 3-month period, parents of children newly diagnosed with TIDM across the UK completed a questionnaire. Additional medical information was collected regarding initial hospital management.

Results: Data was available for 261 children (54% male), median age 10.1 years (range 0.2–16.6 years). 26% presented with diabetic ketoacidosis (DKA); those without classical symptoms of diabetes were more likely to present with DKA (P=0.016).

Median duration of parental concern was 14 days (range 0–548 days). There were positive correlations between HbA1c and both age and symptom duration (both P<0.001). No relationship was identified between duration of parental concern/reported symptoms and age, deprivation index, caregiver education level or family structure.

65% of parents had considered a diagnosis of TIDM, which was more likely if their child had polyuria and/or polydipsia (P<0.001). 86% discussed their concerns regarding a possible diagnosis of T1DM with a healthcare professional (HCP). 76% of children were admitted on the day of first HCP contact: of the remaining patients, median time to admission was 5 days (range 1–152 days). Children with multiple HCP contacts had lower pH on admission and were more likely to require intravenous insulin, whereas if the family had considered the diagnosis the converse was true (all P<0.05).

Median time following admission to diabetes team referral was 1.5 h. First subcutaneous insulin administration occurred at median 2.0 h after admission in children not requiring intravenous insulin.

Conclusions: Parental and HCP consideration of T1DM reduced severity of presentation. Increased awareness of T1DM symptoms in HCP and the general public could reduce time to presentation and the frequency of DKA.