Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon?

Meenal Mavinkurve,Elaine Wan Ling Chan,Nurshadia Samingan,Muhammad Yazid Jalaludin,Mazidah Noordin,Azriyanti Anuar Zaini,Annie Leong

doi:10.3389/fendo.2021.606018

Abstract

BackgroundChildren with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts.AimTo report the rate of misdiagnosis and its associated risk factors in Malaysian children and adolescents with T1DM.MethodsA retrospective analysis of children with T1DM below 18 years of age over a 10 year period was conducted.ResultsThe cohort included 119 children (53.8% female) with a mean age 8.1 SD ± 3.9 years. 38.7% of cases were misdiagnosed, of which respiratory illnesses were the most common (37.0%) misdiagnosis. The rate of misdiagnosis remained the same over the 10 year period. Among the variables examined, younger age at presentation, DKA at presentation, healthcare professional (HCP) contact and admission to the intensive care unit were significantly different between the misdiagnosed and correctly diagnosed groups (p <0.05).ConclusionMisdiagnosis of T1DM occurs more frequently in Malaysian children <5 years of age. Misdiagnosed cases are at a higher risk of presenting in DKA with increased risk of ICU admission and more likely to have had prior HCP contact. Awareness of T1DM amongst healthcare professionals is crucial for early identification, prevention of DKA and reducing rates of misdiagnosis

Highlights

Type 1 diabetes (T1DM) is a common autoimmune condition of childhood with a peak age of onset at 10–14 years of age [1]
The aim of this study is to report on the rate of misdiagnosis of T1DM in Malaysian children and adolescents and the risk factors which predispose to misdiagnosis
All new diagnoses of paediatric T1DM at University Malaya Medical Centre (UMMC) are admitted as inpatients irrespective of whether they present in diabetic ketoacidosis (DKA) or not and all are reviewed by the Paediatric Endocrinology team

Summary

Introduction

Type 1 diabetes (T1DM) is a common autoimmune condition of childhood with a peak age of onset at 10–14 years of age [1]. T1DM is the commonest form of childhood diabetes in Malaysia, accounting for 73%–77% of all childhood diabetes cases as reported by the DiCARe registry [1,2,3]. The International Diabetes Federation reported 977 cases of T1DM in Malaysian children aged 0–19 years in 2019 [4]. In Malaysia, 64.2% of children with T1DM present in DKA at initial diagnosis [3]. Children with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts

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Methods

Results