MBBS, DCH, BSc, PGDipSci, Paediatric Endocrinology Fellow, Department of Endocrinology and Diabetes, Monash Children@s Hospital, Vic.
MB BAO BCh, MRCPI, FRACP, MD, Paediatric Endocrinologist, Department of Endocrinology and Diabetes, The Royal Children@s Hospital, Vic; Honorary Research Fellow, Murdoch Children@s Research Institute, Vic; Honorary Senior Fellow, The University of Melbourne, Vic.
Aust J Gen Pract. 2021 Apr;50(4):246-251. doi: 10.31128/AJGP-04-20-5348.
Same-day referral for tertiary management of suspected childhood type 1 diabetes (T1D) is recommended as best practice. The aim of this study was to review recent primary care practice in managing suspected paediatric T1D and its impact on clinical outcomes.
This was a retrospective cross-sectional study of referral patterns and clinical outcomes of youth aged <18 years with new-onset T1D at two tertiary metropolitan paediatric diabetes centres.
Almost half (73 out of 155) of children and adolescents later diagnosed with T1D had delayed referral; 56% (41 out of 73) had additional pre-referral investigations. Point-of-care (POC) blood/urine glucose testing was associated with increased same-day referral (odds ratio [OR] 14.6; 95% confidence interval [CI]: 5.9, 36.3, P <0.001), reduced pre-referral investigations (OR 0.4; 95% CI: 0.2, 0.9, P = 0.02) and reduced diabetic ketoacidosis (DKA) rates (60.3%, compared with 27.8%, P <0.001).
POC testing facilitated early tertiary referral and reduced DKA rates and unnecessary investigations in children and adolescents with new presentation of T1D.
建议对疑似儿童 1 型糖尿病（T1D）进行当日转诊至三级医疗机构进行管理，这是最佳实践。本研究旨在回顾近期初级保健管理疑似儿科 T1D 的实践情况及其对临床结局的影响。
这是一项对两家三级大都市儿科糖尿病中心新诊断为 T1D 的 18 岁以下青少年转诊模式和临床结局的回顾性横断面研究。
近一半（155 例中有 73 例）后来被诊断为 T1D 的儿童和青少年延迟转诊；56%（41 例中有 41 例）进行了额外的转诊前检查。即时检测（POC）血糖/尿糖检测与当日转诊率增加相关（比值比[OR] 14.6；95%置信区间[CI]：5.9，36.3，P <0.001），转诊前检查减少（OR 0.4；95% CI：0.2，0.9，P = 0.02），糖尿病酮症酸中毒（DKA）发生率降低（60.3%，相比之下，27.8%，P <0.001）。
POC 检测有助于 T1D 新发病例的早期三级转诊，并降低 DKA 发生率和不必要的检查。
