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采用混合方法研究影响 1 型糖尿病延迟诊断的相关因素。

A mixed method approach to understanding the factors surrounding delayed diagnosis of type one diabetes.

机构信息

Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America.

Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America.

出版信息

J Diabetes Complications. 2018 Nov;32(11):1051-1055. doi: 10.1016/j.jdiacomp.2018.08.011. Epub 2018 Aug 14.

Abstract

AIMS

This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding.

METHODS

975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis.

RESULTS

34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39.8% vs. 24.6%), be transported by ambulance or life flight (30.7% vs. 15.3%), be hospitalized (93.7% vs. 83.9%), spend time in an Intensive Care Unit (42.2% vs. 21.3%), and be in diabetic ketoacidosis (DKA) (42.2% vs. 21.3%). Younger children were at increased risk, with higher rates of DKA and fewer days of symptoms. Many parents experienced frustration receiving a prompt diagnosis for their child, including an inability to schedule a physician appointment, proper glucose testing, and concerns being dismissed by professionals.

CONCLUSION

More physician and parent education is needed. Doctors should conduct glucose screenings when diabetes symptoms are present. Parents need education to recognize excessive thirst and frequent urination as reasons to seek medical treatment.

摘要

目的

本研究在美国调查了 1 型糖尿病(T1D)的延迟诊断及其相关严重程度标志物。通过定性反思来深入了解这一问题。

方法

通过滚雪球和社交媒体请求,招募了 975 名 T1D 未成年患儿的家长,让他们完成了一项关于诊断经历的 55 个问题的在线调查。

结果

34%的 T1D 患儿存在延迟诊断。与未延迟诊断的患儿相比,这些患儿更有可能在急诊室诊断(39.8% vs. 24.6%)、通过救护车或直升机转运(30.7% vs. 15.3%)、住院(93.7% vs. 83.9%)、入住重症监护病房(42.2% vs. 21.3%)和出现糖尿病酮症酸中毒(DKA)(42.2% vs. 21.3%)的情况更为常见。年龄较小的患儿风险增加,DKA 的发生率更高,症状持续的天数更少。许多家长在为孩子获得及时诊断时感到沮丧,包括无法预约医生、进行适当的血糖检测,以及专业人士对他们的担忧不屑一顾。

结论

需要加强医生和家长的教育。医生应在出现糖尿病症状时进行血糖筛查。家长需要接受教育,以便能识别过度口渴和频繁排尿是就医的原因。

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