The pathway to diagnosis of type 1 diabetes in children: a questionnaire study
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Usher-Smith, J., Thompson, M. J., Zhu, H., Sharp, S., & Walter, F. (2015). The pathway to diagnosis of type 1 diabetes in children: a questionnaire study. BMJ Open, 5 (e006470)https://doi.org/10.1136/bmjopen-2014-006470
Objective: To explore the pathway to diagnosis of type 1 diabetes (T1D) in children Design: Questionnaire completed by parents Participants: Parents of children aged 1 month to 16 years diagnosed with T1D within the previous three months Setting: Children and parents from 11 hospitals within the East of England. Results: 88/164 (54%) of invited families returned the questionnaire. Children had mean ±SD age of 9.41±4.5 years. 35 (39.8%) presented with DKA at diagnosis. The most common symptoms were polydipsia (97.7%), polyuria (83.9%), tiredness (75.9%), nocturia (73.6%) and weight loss (64.4%) and all children presented with at least one of those symptoms. The time from symptom onset to diagnosis ranged from 2 to 315 days (median 25 days). Most of this was the appraisal interval from symptom onset until perceiving the need to seek medical advice. Access to healthcare was good but one in five children presenting to primary care were not diagnosed at first encounter, most commonly due to waiting for fasting blood tests or alternative diagnoses. Children diagnosed at first consultation had a shorter duration of symptoms (p=0.022) and children whose parents suspected the diagnosis were 1.3 times more likely (RR 1.3, 95% CI 1.02-1.67) to be diagnosed at first consultation. Conclusions: Children present with the known symptoms of T1D but there is considerable scope to improve the diagnostic pathway. Future interventions targeted at parents need to address the tendency of parents to find alternative explanations for symptoms and the perceived barriers to access, in addition to symptom awareness.
The study was funded by the Royal College of General Practitioners Scientific Foundation Board (SFB-2011-15). JUS was supported by a National Institute of Health Research (NIHR) Academic Clinical Fellowship and subsequently Clinical Lectureship, and FMW by an NIHR Clinician Scientist award. SJS was supported by the Medical Research Council www.mrc.ac.uk [Unit Programme number MC_UU_12015/1]. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Medical Research Council (MC_U106179471)
External DOI: https://doi.org/10.1136/bmjopen-2014-006470
This record's URL: https://www.repository.cam.ac.uk/handle/1810/246672
Attribution 2.0 UK: England & Wales
Licence URL: http://creativecommons.org/licenses/by/2.0/uk/