Missed opportunities?

Abstract

The Journal has published a number of studies related to diabetic ketoacidosis (DKA) in the past few years; most of these have made reference to prevention as the best strategy for avoiding the significant morbidity (and occasional mortality) consequent to DKA.In this issue of The Journal, Bui et al in Toronto report an important observation that may have implications for the prevention of DKA. Using a comprehensive Ontario administrative database, they were able to identify nearly 4000 children with newly diagnosed diabetes in a 16 year period and uncover the frequency of visits to medical providers during the month prior to diagnosis.Over one-third of children with newly diagnosed diabetes had visits to medical providers during the month prior to their diagnosis. Many of these were coded for diagnoses involving gastrointestinal (eg, gastroenteritis) or urinary tract (eg, cystitis) disorders. This figure was even higher for children under 3 years of age. A minority of these children had any testing done during these encounters which would have suggested diabetes (e.g. urinalysis, blood sugar), and children who presented with DKA had even less such testing than children who did not present with DKA.This study confirms that many children with new onset diabetes have symptoms significant enough to prompt physician visits before the diagnosis is made. More prompt recognition and appropriate testing might identify such children before they evolve into DKA. The Journal has published a number of studies related to diabetic ketoacidosis (DKA) in the past few years; most of these have made reference to prevention as the best strategy for avoiding the significant morbidity (and occasional mortality) consequent to DKA. In this issue of The Journal, Bui et al in Toronto report an important observation that may have implications for the prevention of DKA. Using a comprehensive Ontario administrative database, they were able to identify nearly 4000 children with newly diagnosed diabetes in a 16 year period and uncover the frequency of visits to medical providers during the month prior to diagnosis. Over one-third of children with newly diagnosed diabetes had visits to medical providers during the month prior to their diagnosis. Many of these were coded for diagnoses involving gastrointestinal (eg, gastroenteritis) or urinary tract (eg, cystitis) disorders. This figure was even higher for children under 3 years of age. A minority of these children had any testing done during these encounters which would have suggested diabetes (e.g. urinalysis, blood sugar), and children who presented with DKA had even less such testing than children who did not present with DKA. This study confirms that many children with new onset diabetes have symptoms significant enough to prompt physician visits before the diagnosis is made. More prompt recognition and appropriate testing might identify such children before they evolve into DKA. Is Diabetic Ketoacidosis at Disease Onset a Result of Missed Diagnosis?The Journal of PediatricsVol. 156Issue 3PreviewTo determine the frequency of medical encounters before diagnosis of diabetes in children in Ontario, Canada; to determine risk factors for diabetic ketoacidosis (DKA). Full-Text PDF