Data highlight opportunities to diagnose type 1 diabetes before DKA onset
medwireNews: Children with type 1 diabetes are more likely than their non-diabetic peers to seek primary care for a number of specific conditions in the year before their diagnosis, which could aid detection before the onset of diabetic ketoacidosis (DKA), say researchers.
Respiratory tract infections (RTIs), vomiting, antibiotic prescriptions, appointments for blood tests, fungal conditions, urinary conditions, and weight concerns were all more common among the 1345 children with type 1 diabetes than among the 4035 matched controls without diabetes.
Julia Townson, from Cardiff University in the UK, and study co-authors believe that, taken together, their findings could “be used to develop a prediction model for use in primary care to promote an earlier diagnosis of diabetes whilst reducing the risk of presentation in DKA.”
In the 12 months before their diagnosis, 96% of children who developed type 1 diabetes had at least one primary care contact compared with 81% of the matched controls, which corresponded to a significant odds ratio (OR) of 6.5.
When broken down into shorter time periods, the data showed that 46.7% of cases had contact with primary care between 1 and 30 days prediagnosis compared with 22.9% of controls during the same period.
A number of specific reasons for seeking primary care during this period were associated with a significantly increased likelihood for diabetes, namely blood tests (OR=10.7), vomiting (OR=9.3), fungal conditions (OR=6.7), weight (OR=6.5), urinary conditions (OR=5.2), and RTIs (OR=1.9).
Between 31 and 360 days prior to diabetes diagnosis, the rates of primary care contact were similar among all study participants overall but were significantly higher for urinary conditions between 31 and 90 days prior to diagnosis and for blood tests between 91 and 180 days prior to diagnosis in the cases versus controls, at ORs for diabetes diagnosis of 1.8 each.
Among the children with diabetes, 19% presented in DKA. Children younger than 2 years of age were a significant 3.2 times more likely to present in DKA than those aged 10–15 years, while boys were 1.3 times more likely than girls to have DKA at diabetes diagnosis.
However, independent of age and gender, primary care contact relating to antibiotics (OR=2.2) or vomiting (OR=3.3) between days 1 and 30 prediagnosis was associated with a significantly greater likelihood for presenting in DKA. Contact for vomiting and RTIs on the day of diagnosis were also associated with a greater likelihood for presenting in DKA, at ORs of 8.7 and 3.9, respectively.
Writing in Pediatric Diabetes, Townson and co-authors say their findings “have important public health implications.”
“They provide robust evidence to inform development of interventions to raise awareness in primary care about how a child may present with new-onset [type 1 diabetes],” the researchers remark.
They add: “This information may be used to refine previous interventions that have been developed to raise public and primary care professional awareness of the symptoms of [type 1 diabetes].”
By Laura Cowen
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