1型糖尿病诊断时的误诊与糖尿病酮症酸中毒：患者及照顾者视角
Misdiagnosis and Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: Patient and Caregiver Perspectives.
作者信息
Muñoz Cynthia, Floreen Anna, Garey Colleen, Karlya Tom, Jelley David, Alonso G Todd, McAuliffe-Fogarty Alicia
机构信息
University of Southern California (USC) Keck School of Medicine, Los Angeles, CA.
USC UCEDD & Endocrinology, Children's Hospital Los Angeles, Los Angeles, CA.
出版信息
Clin Diabetes. 2019 Jul;37(3):276-281. doi: 10.2337/cd18-0088.
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening complication that frequently occurs at diagnosis of type 1 diabetes, occurs more commonly when a patient is misdiagnosed, is the leading cause of death in children with type 1 diabetes, and is associated with worse long-term outcomes. Our retrospective online survey found that 25% of all participants were misdiagnosed and that misdiagnosis was associated with an 18% increased risk for DKA compared to those correctly diagnosed. Adult providers should consider type 1 diabetes when diagnosing type 2 diabetes, and pediatric providers should rule out type 1 diabetes when a patient reports nonspecific viral symptoms.
摘要
糖尿病酮症酸中毒（DKA）是一种危及生命的并发症，常在1型糖尿病诊断时出现，在患者被误诊时更常见，是1型糖尿病患儿的主要死因，且与更差的长期预后相关。我们的回顾性在线调查发现，所有参与者中有25%被误诊，与正确诊断的患者相比，误诊与DKA风险增加18%相关。成年医疗人员在诊断2型糖尿病时应考虑1型糖尿病，儿科医疗人员在患者报告非特异性病毒症状时应排除1型糖尿病。
相似文献
1
Misdiagnosis and Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: Patient and Caregiver Perspectives.
Clin Diabetes. 2019 Jul;37(3):276-281. doi: 10.2337/cd18-0088.
2
[Frequency and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes].
Pediatr Endocrinol Diabetes Metab. 2013;19(4):143-7.
3
Delayed diagnosis and issues with pump usage are the leading causes of diabetic ketoacidosis in children with diabetes living in Newfoundland and Labrador, Canada.
BMC Res Notes. 2015 Apr 16;8:158. doi: 10.1186/s13104-015-1115-y.
4
Diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Tigray, Ethiopia: retrospective observational study.
Pediatric Health Med Ther. 2019 May 23;10:49-55. doi: 10.2147/PHMT.S207165. eCollection 2019.
5
Diabetic Ketoacidosis in Patients with Type 2 Diabetes on Sodium-Glucose Cotransporter-2 Inhibitors - A Case Series.
Rev Recent Clin Trials. 2018;13(2):156-160. doi: 10.2174/1574887113666180314101436.
6
Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK.
Arch Dis Child. 2014 May;99(5):438-42. doi: 10.1136/archdischild-2013-304818. Epub 2014 Jan 6.
7
Diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: Role of demographic, clinical, and biochemical features along with genetic and immunological markers as risk factors. A 20-year experience in a tertiary Belgian center.
Pediatr Diabetes. 2019 Aug;20(5):584-593. doi: 10.1111/pedi.12864. Epub 2019 May 15.
8
Diabetic Ketoacidosis at Onset of Type 1 Diabetes: Rates and Risk Factors Today to 15 Years Ago.
Glob Pediatr Health. 2019 Aug 13;6:2333794X19870394. doi: 10.1177/2333794X19870394. eCollection 2019.
9
Diabetic ketoacidosis incidence in children at first presentation of type 1 diabetes at an Australian regional hospital: The effect of health professional education.
Pediatr Diabetes. 2018 Aug;19(5):993-999. doi: 10.1111/pedi.12666. Epub 2018 Mar 24.
10
Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia.
Medicina (Kaunas). 2019 Jul 10;55(7):362. doi: 10.3390/medicina55070362.
引用本文的文献
1
Type 1 diabetes presenting in adults: Trends, diagnostic challenges and unique features.
Diabetes Obes Metab. 2025 Apr 15. doi: 10.1111/dom.16402.
2
Establishing Screening Programs for Presymptomatic Type 1 Diabetes: Practical Guidance for Diabetes Care Providers.
J Clin Endocrinol Metab. 2025 Jul 15;110(8):2371-2382. doi: 10.1210/clinem/dgaf194.
3
Envisioning Tools to Help Classify Type 1 Diabetes and Type 2 Diabetes in New-Onset Adult Diabetes.
J Diabetes Sci Technol. 2025 Mar 28:19322968251329055. doi: 10.1177/19322968251329055.
4
Real-world experiences of adult individuals or caregivers of children who received teplizumab treatment in stage 2 type 1 diabetes.
Diabetes Obes Metab. 2025 May;27(5):2495-2506. doi: 10.1111/dom.16246. Epub 2025 Feb 13.
5
Investigating misclassification of type 1 diabetes in a population-based cohort of British Pakistanis and Bangladeshis using polygenic risk scores.
Sci Rep. 2025 Jan 13;15(1):1168. doi: 10.1038/s41598-024-80348-8.
6
Methodology for Safe and Secure AI in Diabetes Management.
J Diabetes Sci Technol. 2025 May;19(3):620-627. doi: 10.1177/19322968241304434. Epub 2024 Dec 26.
7
Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study.
Diagnosis (Berl). 2024 Jun 27;11(4):416-421. doi: 10.1515/dx-2024-0024. eCollection 2024 Nov 1.
8
Consensus Guidance for Monitoring Individuals With Islet Autoantibody-Positive Pre-Stage 3 Type 1 Diabetes.
Diabetes Care. 2024 Aug 1;47(8):1276-1298. doi: 10.2337/dci24-0042.
9
Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes.
Diabetologia. 2024 Sep;67(9):1731-1759. doi: 10.1007/s00125-024-06205-5.
10
Type 1 Diabetes Genetic Risk in 109,954 Veterans With Adult-Onset Diabetes: The Million Veteran Program (MVP).
Diabetes Care. 2024 Jun 1;47(6):1032-1041. doi: 10.2337/dc23-1927.
本文引用的文献
1
15. Diabetes Advocacy: .
Diabetes Care. 2018 Jan;41(Suppl 1):S152-S153. doi: 10.2337/dc18-S015.
2
Diabetes Care Disparities in Long-standing Type 1 Diabetes in Canada and the U.S.: A Cross-sectional Comparison.
Diabetes Care. 2018 Jan;41(1):88-95. doi: 10.2337/dc17-1074. Epub 2017 Nov 8.
3
The unique clinical spectrum of maturity onset diabetes of the young type 3.
Diabetes Res Clin Pract. 2018 Jan;135:18-22. doi: 10.1016/j.diabres.2017.10.024. Epub 2017 Oct 28.
4
The Role of Laboratory Testing in Differentiating Type 1 Diabetes from Type 2 Diabetes in Patients Undergoing Bariatric Surgery.
Obes Surg. 2018 Jan;28(1):25-30. doi: 10.1007/s11695-017-2804-5.
5
Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control.
Diabetes Care. 2017 Sep;40(9):1249-1255. doi: 10.2337/dc17-0558. Epub 2017 Jun 30.
6
Ketoacidosis at diagnosis of type 1 diabetes: Effect of prospective studies with newborn genetic screening and follow up of risk children.
Pediatr Diabetes. 2018 Mar;19(2):314-319. doi: 10.1111/pedi.12541. Epub 2017 May 23.
7
A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes.
PLoS One. 2017 May 1;12(5):e0176860. doi: 10.1371/journal.pone.0176860. eCollection 2017.
8
Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012.
N Engl J Med. 2017 Apr 13;376(15):1419-1429. doi: 10.1056/NEJMoa1610187.
9
Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: Evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014.
Pediatr Diabetes. 2017 Nov;18(7):553-558. doi: 10.1111/pedi.12456. Epub 2016 Oct 11.
10
A survey of youth with new onset type 1 diabetes: Opportunities to reduce diabetic ketoacidosis.
Pediatr Diabetes. 2017 Nov;18(7):547-552. doi: 10.1111/pedi.12455. Epub 2016 Oct 11.
Zotero 插件