ESPE Abstracts

Aim and Method: Diagnosis of type 1 diabetes (T1DM) may be delayed in some children, despite seeking medical care by the family. In this prospective/observational study, the time and process from consulting with a doctor to getting diagnosed with diabetes was investigated in patients hospitalized for newly diagnosed T1DM between 2021-2022.

Results: During the study period total of 114 newly diagnosed T1DM patients (49%F, age: 9.29±4.2 years) were admitted.102 patients were diagnosed elsewhere and referred to our hospital for treatment.53 patients applied initially to a pediatrician. T1DM diagnosis was missed in 9 (17%) at the first application. Eight of them were diagnosed at their second application.49 patients applied initially to a family physician.T1DM diagnosis was missed in 12 (24%) at the first application. Eleven of them were diagnosed their second application. Of the patients whose diagnosis was missed at the first application, 24% were diagnosed with upper respiratory tract infection, 5% with gastroenteritis, and 71% did´nt receive a diagnosis. In all patients, the average number of doctor visits until the diagnosis of DM was 1.28. The time from patient seeking medical care to hospitalization was 2.09 ±3.6 (0-21) days. 4/44 (9%) and 10/37 (27%) of the patients diagnosed with T1DM (by a pediatrician and by a family physician respectively) had sought a second opinion. While all 12 patients with a family history of T1DM were diagnosed at their first presentation to a doctor, this rate was 75% in those who did not. In 23% (26/114) of the patients, the family suspected the diagnosis of DM and reported it to their doctor, but despite this, 4 of them could be diagnosed at the second consultation. HbA1c of the patients who applied with suspicion of DM was lower than those who applied without suspecting the diagnosis of DM (11.45±2.03% and 12.85±2.56, respectively, (p:0.002). However, DKA (50.6% vs. 66.6%) and severe DKA (27% vs. 50%) were higher in those who could not be diagnosed at the first application (p:0.22). In those presenting with DKA, HbA1c levels were higher in patients whose mothers had less than high school education (13.03±2.4% vs. 11.4±2.3%, p:0.0010).

Summary of Results: The diagnosis of T1DM can be missed by 17% and 24% at the first examination by pediatrician and family physicians. However, the high rate of DKA at diagnosis of T1DM in our cohort suggests that families are delayed in seeking medical care. Families' awareness of DM contributes to early diagnosis.