Background: The prevalence of childhood type 1 diabetes mellitus (T1DM) is increasing and the age at presentation is falling. Late presentation with diabetic ketoacidosis (DKA) is more common in younger children who are at increased risk of cerebral oedema.
Objective and hypotheses: To describe the clinical presentation of new onset T1DM to our centre and report time to diagnosis, incidence of DKA, requirement for intensive care and complications.
Method: Retrospective case review of all children with new onset T1DM from 20042012 at The Childrens University Hospital, Temple Street, Dublin. DKA was classified as mild (pH<7.3), moderate (pH<7.2) and severe (pH<7.1).
Results: Over the study period 281 patients (129 males) presented with new onset T1DM (87 05 years, 120 611 years, and 74 1216 years). Twenty-two patients presented in 2004 compared with 46 in 2012. Mean age at diagnosis was 8.8 years (range 0.6615.6 years). Most (95%) presented with classical symptoms. DKA was seen in 31% of the cohort at presentation (45.9% mild, 26.4% moderate, and 27.5% severe) but occurred more commonly in younger children (68% of those <2 years). Eleven percent of all children and 44% of those <2 years required intensive care. Two patients (0.71%) developed cerebral oedema. The mean time to diagnosis from first contact with health care professional (HCP) was 20.6 days (range 2140 days). Factors associated with early diagnosis were having a family member with type 1 diabetes (P=18) and older age.
Conclusion: The incidence of T1DM in our centre is rising rapidly and the age at presentation is falling. Younger children tend to present later and are more often in DKA. Recognition is more difficult in the young child. Greater HCP awareness and implementation of national guidelines for management of DKA are critical to good outcomes.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology