Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Victoria, Australia
NHMRC Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes Career Development Program, Melbourne, Victoria, Australia.
BMJ Open. 2024 Oct 1;14(10):e085635. doi: 10.1136/bmjopen-2024-085635.
Diabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit their general practitioner (GP) the week prior to developing DKA, with similar trends observed internationally.
To summarise interventions in general practice to reduce diagnostic delay in paediatric T1DM and to evaluate their effectiveness.
Six databases (Ovid, Web of Science, CINAHL, Evidence-Based Medicine Reviews, Google Scholar and EMBASE) were searched. Any English language, less than 20 years study involving interventions targeting GPs specifically in the prevention of paediatric DKA, was included. Primary outcomes were (a) the number of children presenting to the hospital in DKA following diagnostic delay after a GP visit and (b) DKA rate. The secondary outcome was changes in GPs' behaviour regarding timeliness of referrals. Two reviewers completed title, abstract and full-text review, with conflicts resolved by a third reviewer. ROBINS-I risk of bias was used for appraisal. High heterogeneity among studies rendered meta-analysis unsuitable. Structured tabulation of results was completed for analysis. The date of last search was 2 July 2023.
Eight studies were included (three conference abstracts and five peer-reviewed publications.) We identified six intervention types attempting to facilitate timely diagnosis of type 1 diabetes in the general practice setting: direct communication, indirect communication, education sessions, electronic clinical decision support tools, updated referral pathways and provision of glucose and/or ketone monitors. Due to the limited number of peer-reviewed studies identified by this review, we were not able to identify the extent to which these interventions were successful.
Paucity of information regarding study methodology and high heterogeneity among study design and outcome measures limited our conclusions regarding acceptability, effectiveness and reach. Future studies should include GPs in their design and consider the sustainability of interventions in the long term.
CRD42023412504.
糖尿病酮症酸中毒（DKA）是一种危及生命的紧急情况，可能是 1 型糖尿病（T1DM）诊断延迟的结果。四分之三的澳大利亚新诊断为 T1DM 的儿童在发生 DKA 的前一周会去看全科医生（GP），国际上也观察到类似的趋势。
总结全科医生在减少儿科 T1DM 诊断延迟方面的干预措施，并评估其效果。
检索了 6 个数据库（Ovid、Web of Science、CINAHL、循证医学评价、Google Scholar 和 EMBASE）。纳入的研究为英文文献，研究年限不超过 20 年，且包含专门针对预防儿科 DKA 的全科医生干预措施。主要结局指标为：（a）GP 就诊后因诊断延迟而导致儿童住院的 DKA 人数；（b）DKA 发生率。次要结局为 GP 行为的变化，即转诊的及时性。两名评审员完成了标题、摘要和全文的评审，有争议的地方由第三名评审员解决。使用 ROBINS-I 风险偏倚评估进行评价。由于研究之间存在高度异质性，不适合进行荟萃分析。采用结构化表格对结果进行分析。最后一次搜索日期为 2023 年 7 月 2 日。
纳入了 8 项研究（3 项会议摘要和 5 项同行评审出版物）。我们确定了 6 种试图在全科医疗环境中促进 1 型糖尿病及时诊断的干预类型：直接沟通、间接沟通、教育课程、电子临床决策支持工具、更新转诊途径以及提供血糖和/或酮体监测仪。由于本综述仅确定了有限数量的同行评审研究，因此我们无法确定这些干预措施的成功程度。
由于研究方法的信息有限，且研究设计和结局指标的高度异质性，限制了我们对可接受性、有效性和覆盖面的结论。未来的研究应将全科医生纳入研究设计，并考虑干预措施在长期内的可持续性。
PROSPERO 注册号：CRD42023412504。
