The Department of Paediatrics, Hematology, Oncology and Endocrinology, Medical University in Gdańsk ul. Debinki 7 80-952 Gdańsk, Poland.
Pediatr Diabetes. 2009 Dec;10(8):542-9. doi: 10.1111/j.1399-5448.2009.00516.x. Epub 2009 May 28.
Diabetic ketoacidosis (DKA) development in children with new-onset type 1 diabetes (T1DM) is often the main consequence of delayed diagnosis. The aim of the study was to estimate the frequency of difficulties in T1DM diagnosis and to investigate if and how the demographic factors (gender, patient's age at presentation, family history of T1DM, level of maternal education, place of residence, and health service unit the patient called at) have any influence on diagnostic delays.
Retrospective analysis of 474 children (243 boys-51.27% and 231 girls -48.73%) with new-onset T1DM aged below 17 yr and living in the Pomeranian region of Poland was carried out. The delay in diagnosis was recognized if the patient was not diagnosed on the first visit because of omission, wrong interpretation of main diabetic symptoms, exclusive treatment of additional signs, or concomitant diseases.
Difficulties in diagnosing T1DM were found in 67 cases (14.13%) and they are the main cause of DKA development in these children (p = 0.00). Among the examined demographic factors, mainly the patient's age at presentation has a significant influence on diagnostic delays (p = 0.01), especially in children below 2 yr (p = 0.00). Most frequently family doctors were responsible for wrong preliminary diagnosis.
Difficulties in diagnosing T1DM are a significant cause of DKA development in children with new-onset disease. Patient's age at presentation is the main risk factor of delayed diagnosis, especially in children below 2 yr. The increase in awareness among pediatricians concerning the possibility of T1DM development in children is needed.
儿童新发 1 型糖尿病（T1DM）患者发生糖尿病酮症酸中毒（DKA）往往是诊断延迟的主要后果。本研究旨在评估 T1DM 诊断困难的频率，并探讨人口统计学因素（性别、发病时患者年龄、T1DM 家族史、母亲受教育程度、居住地和患者就诊的医疗服务单位）是否以及如何影响诊断延迟。
对居住在波兰波美拉尼亚地区的 474 名年龄在 17 岁以下的新发 T1DM 儿童（243 名男孩，占 51.27%；231 名女孩，占 48.73%）进行了回顾性分析。如果患者因遗漏、错误解释主要糖尿病症状、仅治疗其他症状或合并疾病而未在首次就诊时被诊断为 T1DM，则认为存在诊断延迟。
发现 67 例（14.13%）T1DM 诊断困难，这是这些儿童发生 DKA 的主要原因（p = 0.00）。在所检查的人口统计学因素中，主要是患者发病时的年龄对诊断延迟有显著影响（p = 0.01），尤其是在 2 岁以下的儿童中（p = 0.00）。最常见的是家庭医生对初步诊断有误。
T1DM 诊断困难是儿童新发疾病发生 DKA 的重要原因。患者发病时的年龄是诊断延迟的主要危险因素，尤其是在 2 岁以下的儿童中。需要提高儿科医生对儿童可能发生 T1DM 的认识。
