Department of Paediatric Endocrinology, University Hospital Southampton, , Southampton, UK.
Arch Dis Child. 2014 May;99(5):438-42. doi: 10.1136/archdischild-2013-304818. Epub 2014 Jan 6.
Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes, and at diagnosis might represent delayed presentation. The extent and reasons for delays are unclear, but identifying and targeting factors associated with DKA could reduce this incidence.
To compare the patient pathway before diagnosis of type 1 diabetes mellitus (T1DM) in children presenting with DKA and non-acidotic hyperglycaemia.
DESIGN, SETTING AND PATIENTS: Over a 3-month period, children newly diagnosed with T1DM were identified on admission to UK hospitals. Parents and medical teams completed a questionnaire about events before diagnosis.
Data were available for 261 children (54% male), median age 10.3y (range 0.8-16.6 y). 25% presented with DKA, but more commonly in children <2y (80% vs 23%, p<0.001). Fewer children with DKA reported polyuria (76% vs 86%) or polydipsia (86% vs 94%) (both p<0.05), but more reported fatigue (74% vs 52%) and weight loss (75% vs 54%) (both p<0.01). 24% of children had multiple healthcare professional (HCP) contacts, and these children had lower pH on admission. 46% of children with a delayed presentation to secondary care had non-urgent investigations. 64% of parents had considered a diagnosis of diabetes, and these children were less likely to present with DKA (13% vs 47%, p<0.001).
Multiple HCP contacts increased risk of presentation in DKA, whereas, parental awareness of diabetes was protective. Improved public and health professional education targeting non-classical symptoms, awareness of diabetes in under 2 y, and point-of-care testing could reduce DKA at diagnosis of diabetes.
糖尿病酮症酸中毒（DKA）是儿童糖尿病死亡的主要原因，在诊断时可能代表延迟就诊。DKA 延迟的程度和原因尚不清楚，但识别和针对与 DKA 相关的因素可能会降低这种发病率。
比较以 DKA 和非酸中毒性高血糖就诊的儿童在诊断为 1 型糖尿病（T1DM）前的患者就诊途径。
设计、地点和患者：在 3 个月的时间内，在英国医院入院时发现新诊断为 T1DM 的儿童。家长和医疗团队完成了一份关于诊断前事件的问卷。
共有 261 名儿童（54%为男性）的数据可用，中位年龄为 10.3 岁（范围为 0.8-16.6 岁）。25%的儿童表现为 DKA，但<2 岁的儿童更为常见（80% vs 23%，p<0.001）。报告有多尿（76% vs 86%）或多饮（86% vs 94%）的儿童较少（均 p<0.05），但报告疲劳（74% vs 52%）和体重减轻（75% vs 54%）的儿童更多（均 p<0.01）。24%的儿童有多个医疗保健专业人员（HCP）的接触，这些儿童入院时的 pH 值较低。在二级保健中延迟就诊的儿童中，有 46%进行了非紧急检查。64%的家长曾考虑过糖尿病的诊断，这些儿童不太可能出现 DKA（13% vs 47%，p<0.001）。
与 HCP 的多次接触增加了 DKA 就诊的风险，而家长对糖尿病的认识具有保护作用。提高针对非典型症状的公众和卫生专业人员教育、提高对 2 岁以下儿童的糖尿病认识，以及即时检测，可能会降低糖尿病的 DKA 诊断率。
