Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Pediatr Diabetes. 2019 May;20(3):330-338. doi: 10.1111/pedi.12829. Epub 2019 Mar 7.
To evaluate primary care presentations during the prodrome (12 months prior to onset type-1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis.
This was a case-control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA.
A total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047).
There are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA.
评估前驱期（1 型糖尿病（T1D）发病前 12 个月）的初级保健表现，无论是否伴有糖尿病酮症酸中毒（DKA），以寻找更早诊断的机会。
这是一项病例对照研究，将 16 年来威尔士（英国）儿童（≤15 岁）登记的 T1D 诊断数据与常规收集的初级保健记录相关联。对照（无 T1D）按 3:1 的比例匹配。使用条件逻辑回归模型比较病例（患有 T1D 的儿童）和对照的特征；以及表现为有/无 DKA 的病例。
共确定了 1345 例 T1D 患儿（19%为 DKA）和 4035 名对照。在诊断前的 12 个月中，病例发生至少一次初级保健接触的可能性是对照组的 6.5 倍（P<0.001）。在诊断前 1 至 30 天，与血液检查、真菌感染、呼吸道感染（RTI）、尿路感染、呕吐和体重相关的接触与 T1D 独立相关，与诊断前 91 至 180 天相关的血液检查相关接触也是如此。在诊断前一个月内有与 RTI、抗生素处方和呕吐相关的接触的儿童，更有可能发生 DKA，男孩也是如此（P=0.047）。
在初级保健中存在更早诊断儿童 T1D 的机会。这些数据可用于创建预测性诊断工具，作为初级保健医疗专业人员的潜在辅助工具，以预防 DKA 发作。
