Doctors in Southampton and Oxford have warned that UK health professionals’ failure to recognise the symptoms of type 1 diabetes is putting children’s lives at risk.
Dr Justin Davies, a consultant paediatric endocrinologist at Southampton Children’s Hospital, said a lack of awareness meant patients were being sent to multiple clinicians, having unnecessary investigations, missing out on crucial finger-prick blood tests and, ultimately, receiving misdiagnoses.
When treatment with insulin is delayed, patients with type 1 diabetes are at increased risk of a potentially fatal complication diabetic ketoacidosis (DKA), which occurs when the body breaks down fat as an alternative source of fuel in the absence of insulin.
DKA is present in 25% of the 2,000 children newly diagnosed with type 1 diabetes annually in the UK and is responsible for ten deaths a year.
“Despite improvements in diabetes care leading to increased life expectancy, the mortality rate for children with type 1 diabetes remains higher than the general population and DKA is the leading cause of death,” explained Dr Davies.
“Unfortunately, the incidence of DKA in a quarter of patients at diagnosis is relatively unchanged from reports over the past 20 years and nearly twice as high as that observed in Sweden. This is a major concern.”
In the largest study of its kind, published in the journal Archives of Disease in Childhood, the research team examined the symptoms in the lead up to the diagnosis of type 1 diabetes in 261 children aged between eight months and 16 years at 75 hospitals in England, Wales and Northern Ireland before diagnosis.
Dr Davies said while a quarter of all children presented with DKA at diagnosis of type 1 diabetes, the results showed a “worrying tendency” to overlook the possibility of diabetes in children under two, with more than three-quarters (80%) affected by DKA at diagnosis compared to just 23% in older children.
A third of all children with DKA had seen multiple health professionals before the diagnosis was made, but the proportion rose to more than two-thirds (69%) in children under the age of two, largely because they often lacked the classical symptoms of going to the toilet more frequently, bed-wetting and excessive thirst.
Dr Kemi Lokulo-Sodipe, a research fellow at Southampton Children’s Hospital and co-author of the study, said there was a “specific and desperate need” to increase public and professional awareness that diabetes does occur in very young children and what to look for in this age group.
“As a nation, we need to emphasise that diabetes is common and the incidence is increasing,” she explained.
“It can present in babies and young children and it should be at the top of the list in any child with increased toileting – including heavy wet nappies and bedwetting – but also weight loss and fatigue.
“When symptomatic children with undiagnosed type 1 diabetes had multiple contacts with health professionals, they were more likely to present with DKA and this is very concerning as we know early diagnosis is essential to enable treatment with insulin and avoid complications.”
Dr Julie Edge, a consultant in paediatric diabetes at Oxford Children’s Hospital, added: “The diagnosis of diabetes can be made very quickly with a finger-prick test of blood glucose level and no other investigations are necessary.
“All parents should ask for this to be done at the first presentation to their GP if they believe their child may have diabetes and, once diagnosed, children should be referred on the same day to the local children’s diabetes team.”
Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK, K Lokulo-Sodipe, R J Moon, J A Edge, J H Davies, Archives of Disease in Childhood, DOI:10.1136/archdischild-2013-304818, published online 6 January 2014.