A point-of-care test increases same-day referral and reduces DKA in children with new-onset type 1 diabetes

Abstract

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 withnew-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.