Endocrine Abstracts

Background: Type 1 diabetes (T1D) is characterised by autoimmune destruction of pancreatic beta cells leading to insulin deficiency. Prompt referral and treatment is important to prevent diabetic ketoacidosis (DKA) which remains the commonest cause of death in this condition. NICE guidance 2004, advises same day referral to specialist paediatric Diabetes team when childhood diabetes is suspected.

Aim: The aim was to audit the timeliness of referrals of children with suspected T1D to paediatric diabetes team, as well as reasons for any delay.

Method: This was retrospective case notes review of children diagnosed with diabetes mellitus (DM) between 1 January 2005 and 31 December 2014 and managed by Sandwell Paediatric Diabetes service. We reviewed demographic data, information on source of referral, date of initial presentation to a health care professional, date of insulin initiation, cause of delayed presentation (where applicable), date of initial diagnostic blood tests and mode of presentation.

Statistical analysis was carried out using Minitab 17.

Results: A total of 117 children were diagnosed with diabetes in the study period. 21 were excluded as 9 (7.7%) had T2DM, 1 (0.85%) had glucokinase deficiency and 11 (9.4%) children were diagnosed elsewhere and transferred later to our service.

96 children with T1D were included in the study. Mean age at presentation was 8.6 years (S.D. ±3.8 years), 49 (51.04%) were males and 68 (70.83%) were White British. Main sources of referral were General Practitioners in 55 (59.14%) and emergency department in 24 (25.81%). 33 (34.37%) children presented in DKA. In a regression analysis, presentation in DKA was significantly associated with younger age at presentation (P=0.033) and delay in referral (P=0.01). There was no significant association between DKA at presentation and sex, ethnicity, family history of DM or source of referral.

There was a delay in referral in 35 (36.54%) children. 19 (79.17%) of these children presented in DKA. Mean duration of delay in presentation was 2.96 days (S.D.±3.183 days). The commonest reason for delayed presentation was delayed referral due to GP requesting fasting blood glucose in 71.4% (25/35)

Conclusion: In children suspected of having DM, requesting fasting blood glucose to confirm the diagnosis leads to delayed referral to Paediatric diabetes team putting the child at risk of developing DKA.