Diagnosis Of Diabetes In Children Research Articles

Health Care Use Prior to Diabetes Diagnosis in Children Before and During COVID.

During COVID-19, healthcare systems reorganized with less ambulatory care and a shift to virtual care (1). There was an increase in diabetic ketoacidosis (DKA), a preventable, life-threatening condition, at diabetes onset in children during COVID-19 (2). DKA at diabetes onset has been attributed to delays in seeking care, missed diagnosis or delays in referral following a primary healthcare contact (3). Reasons for the recent increase in DKA may relate to hesitancy to seek care, providers failing to recognize diabetes symptoms due to cognitive bias focusing on COVID-19, or limitations of virtual care. To explore these potential mechanisms, we compared in-person and virtual primary care and emergency department (ED) visits in children four weeks prior to diagnosis, before and during COVID-19. If increased DKA rates during COVID-19 were due to more missed diagnoses, possibly related to virtual visits, children with DKA would be more likely to have visits during vs. pre-COVID-19. If families were hesitant to seek or unable to access care during COVID-19, then among those with no visits, there would be a higher proportion with DKA.

Alarming Increase of Ketoacidosis Prevalence at Type 1 Diabetes-Onset in Austria-Results From a Nationwide Registry.

ObjectiveWe analyzed the annual prevalence of onset-DKA (diabetic ketoacidosis) from 2012 to 2020 with a sub-analysis for lockdown-periods during the COVID-19 pandemic in 2020.DesignAll newly diagnosed children with type 1 diabetes (T1D) aged <15 years are prospectively registered in the population-based Austrian Diabetes Incidence Study in Austria.Main Outcome MeasuresThe annual DKA prevalence was analyzed using Joinpoint regression. Definition of DKA: pH <7.3, mild DKA: pH 7.3 to ≤ 7.1, severe DKA: pH <7.1. DKA prevalence during the lockdown periods in 2020 and the corresponding periods in 2015–2019 were examined using Fisher's exact test.ResultsIn the years 2012–2020 the mean prevalence for onset-DKA in Austria was 43.6% [95%CI (confidence interval): 41.6, 45.7] and thus above the mean prevalence of previous decades (1989–2011) of 37,1 % (95%CI: 35.6, 38.6). A particularly high prevalence was found among children <2 years of age (72.0% DKA, 32.8% severe DKA). No significant gender difference was found. Prevalence of severe DKA at T1D-onset increased significantly since 2015 (p = 0.023). During the lockdown in 2020, 59.3% of children were diagnosed with DKA at T1D-onset, compared to 42.1% during the previous 5 years (p = 0.022). Moreover, 20% of children had severe DKA at T1D diagnosis, compared to 14% during the comparison period.ConclusionsThe previously already high prevalence of DKA at T1D-onset has further increased over time. The COVID-19 pandemic has exacerbated the problem of a late or delayed diagnosis of diabetes in children resulting in onset-DKA. The alarmingly increased prevalence of DKA in Austrian children with T1D calls for urgent action.

Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework.

The rate of diabetic ketoacidosis (DKA), a preventable, life-threatening complication of diabetes, at the time of diagnosis in children remains unacceptably high worldwide. We describe our initial approach to selecting a national DKA prevention strategy, to be implemented by the Canadian Pediatric Endocrine Group DKA Prevention Working Group, informed by a framework for behavior change interventions. Existing interventions were identified from a systematic review and our own gray literature search. We then characterized interventions using the Behavior Change Wheel, a framework to inform and drive behavior change, and matched interventions to behavioral targets, audiences, and identified barriers and facilitators. Feedback from the CPEG DKA prevention working group was incorporated into the intervention plan. We identified 27 interventions. Our proposed target behaviors are: (1) prompt recognition of symptoms of diabetes in children; (2) urgent attendance to medical care with a request for an office-based test for diabetes; and (3) rapid confirmation of diagnosis and urgent consultation with pediatric diabetes experts. We initially identified four possible intervention functions including education, training, environment restructuring, and enablement. Feedback from the working group favored education intervention functions including symptom recognition messages targeting parents, caregivers, teachers, and providers and messages about how to make a rapid diagnosis and need for urgent referral targeting providers. The Behavior Change Wheel has been used successfully in selecting interventions in other clinical areas. We describe how we used this framework to provide a foundation for developing an intervention to prevent DKA at diabetes diagnosis in children.

Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic.

ObjectiveThe COVID‐19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID‐19 public health measures were enacted.Research Design and MethodsA retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Rates of DKA and severe DKA were compared to the same time period in the year 2019 (pre‐pandemic control).ResultsThe number of children presenting with newly diagnosed DM1 was similar during the pandemic year of 2020 compared with 2019 (107 children in 2020 vs. 114 in 2019). The frequency of DKA at DM1 onset was significantly higher in the pandemic period (68.2% vs 45.6%; p < 0.001) and incidence of severe DKA was also higher (27.1% in 2020 vs 13.2% in 2019; p = 0.01).ConclusionsThere was a significant increase in DKA and severe DKA in children presenting with new onset DM1 during the COVID‐19 pandemic period. This emphasizes the need for educating health care professionals and families to be aware of the symptoms of hyperglycemia and the importance of early diagnosis and treatment even during public health measures for COVID‐19.

Effectiveness of Diabetes Symptoms Awareness Campaigns on Preventing Diabetes Ketoacidosis at Diagnosis of Type 1 Diabetes: A Systematic Review and Meta-Analysis

Background: Despite efforts to promote an early type 1 diabetes diagnosis, Diabetic Ketoacidosis (DKA) amongst children and adolescents worldwide remains high. This article evaluated the effectiveness of intervention campaigns aimed at reducing the frequency of DKA at type 1 diabetes diagnosis in children and adolescents. Methods: The search strategies included PubMed, Scopus, CINAHL and Web of Science electronic databases, a hand search of select journals and grey literature. Studies included community-based interventions that assessed variation in the frequency of DKA related to awareness campaign interventions focused on children and adolescents younger than 18 years old. The difference in DKA frequency was measured in two separate comparisons. DKA frequency at diabetes diagnosis before and after intervention campaigns, and the difference in DKA frequency between areas with and without and intervention. Findings: Of 1136 records identified, 14 studies were eligible for the analysis. The first group of 12 studies measured DKA at diagnosis, before (n=6548 individuals) and after (n=4931 individuals) the awareness campaigns. The pooled difference in DKA frequency before and after an awareness campaign was 7.20% (95%CI: 0.99-13.41) The second group of four studies measured the difference in an area with no intervention (n=338 individuals) and in an area with an awareness campaign (n=187 individuals). The pooled difference in DKA was 35.71% (95%CI: 5.81-65.61). Interpretation: This review demonstrated that DKA awareness campaigns are effective to reduce DKA among children and adolescents with type 1 diabetes. Moreover, this study demonstrated why these campaigns are effective as it summarized the core components contributing to outcomes. These components can guide future intervention campaigns and serve as the basis for future research. Funding Statement: None. Declaration of Interests: No potential conflicts of interest relevant to this article were reported.

C-peptide and antibody testing to aid diabetes diagnosis in children and young people

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Diabetic Ketoacidosis (DKA) at Diabetes Diagnosis in Children (0-18 years) in Ontario, Canada: A Population-Based Retrospective Cohort Study of Health Administrative Data

IntroductionDiabetic ketoacidosis (DKA), a life-threatening complication of diabetes, is the leading cause of mortality and disability in children. The high cost of care for DKA and negative consequences of DKA on child’s health are known; however, the pediatric DKA trends in Ontario were not studied in the last fifteen years.&#x0D; Objectives and ApproachTo examine time trends of the prevalence of pediatric DKA at diabetes diagnosis and socio-demographic characteristics associated with the DKA risk (child’s sex; age; geographic region; rural residence; material deprivation and ethnic concentration) in Ontario, Canada. Person-level de-identified data from the provincial registry for all Ontario children (0-18 years) newly diagnosed with diabetes (type 1 and 2) in 2004-2012 was linked with records in the national discharge abstract database (CIHI DAD) at the Institute for Clinical and Evaluative Sciences (ICES). SAS software (v.9.3) was used for Poisson and logistic regressions.&#x0D; ResultsOf 10,617 children diagnosed with diabetes, 15.5% were diagnosed during a hospital admission for DKA. Prevalence of DKA at diagnosis did not change over the nine-year period (ptrend =0.99). There were statistically significant within-province regional differences in DKA prevalence at diabetes diagnosis, with the highest prevalence in South-Western Ontario (17.2%). Younger children (0-6 years and 7-12 years) were at higher DKA risk than 13-18 years old children (adjusted odds ratio (OR) 2.5 95% CI 2.2-2.8 and 2.1 95% CI 1.9-2.4). DKA at diabetes diagnosis was associated with material deprivation in young children (0-6 years)(OR 1.9 95% CI 1.4-2.5 for “most deprived” versus “least deprived”). In the older group (13-18 years), boys were at higher DKA risk than girls (OR 1.4 95% CI 1.1-1.7).&#x0D; Conclusion/ImplicationsPrevalence of pediatric DKA at diabetes diagnosis in Ontario is among the lowest in the world; however, higher DKA prevalence among children residing in some geographic regions or most deprived neighbourhoods of the province despite the universal access to government-funded health care warrants further research.

Family adjustment to diabetes diagnosis in children: Can participation in a study on type 1 diabetes genetic risk be helpful?

Diagnosis of type 1 diabetes often causes a negative psychological impact on families. We examined whether parents and children enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study differ in their psychological adjustment to diabetes diagnosis compared to children diagnosed with diabetes in the community. TEDDY follows 8676 children at genetic risk for type 1 diabetes from birth. Fifty-four TEDDY children diagnosed with diabetes and 54 age-matched community control children diagnosed with diabetes were enrolled. Participants were aged 3 to 10 years and study visits occurred at 3, 6, and 12 months postdiagnosis. Psychological measures included an adapted diabetes-specific State Anxiety Inventory, the Pediatric Quality of Life Inventory-Diabetes Module, and the Pediatric Inventory for Parents, which measures frequency and difficulty of parenting stress. A generalized estimating equation analysis based on a difference score between TEDDY children and community controls found no significant differences between TEDDY parents and community controls on parent diabetes-specific anxiety (P = .30). However, TEDDY children exhibited better diabetes-specific quality of life (P = .03) and TEDDY parents reported lower frequency (P = .004) and difficulty (P = .008) of parenting stress compared to community controls. Children diagnosed with at-risk for type 1 diabetes who have previously enrolled in research monitoring have improved diabetes quality of life and lower parenting stress postdiagnosis compared to children diagnosed in the community. Families in follow-up studies may be more prepared if their child is diagnosed with diabetes.

290 The utility of serial continuous glucose monitoring for diagnosis of CF-related diabetes in children

290 The utility of serial continuous glucose monitoring for diagnosis of CF-related diabetes in children

The diagnosis of insulin dependent diabetes in children and teenagers

The conditions of the announcement of the diagnosis of diabetes in children and teenagers are key to helping them live as best as possible with the constraints of this chronic disease. The psychologist works as a mediator in order that the suffering of the child and their family is listened to and contained within the nursing team. This support facilitates the adaptation and reorganisation of their day-to-day life.

Study of somatosensory evoked potentials in children with newly diagnosed type I diabetes

Diabetes is a common metabolic disorder, which causes multi-organ complications. Sensory dominant polyneuropathy and autonomic nervous system neuropathy are recognized as the most common clinical pictures of the nervous system disorders caused by diabetes. Pathological changes in the central nervous system in diabetic patients are relatively unknown and can be referred to as diabetic encephalopathy. The mechanisms underlying this complication remains still poorly understood. Measurable subclinical manifestations are electrophysiological changes, including the impairment of the somatosensory evoked potentials. Aim of the study was to detect possible subclinical features of diabetic neuropathy and/or encephalopathy by investigating peripheral and central somatosensory conduction in children with newly diagnosed type I diabetes. Thirteen children with newly diagnosed type I diabetes (suffering from diabetes no longer than 24 months) were involved in the study of somatosensory evoked potentials. Latencies of potentials N9, N13, N20, P25, peripheral conduction time and central conduction time were analyzed. The control group consisted of 24 age-matched children with tension type headache. All of the analyzed evoked potentials parameters were in the normal range. No significant differences between diabetic and control children were found. Our results indicate that during the first 2 years from diabetes diagnosis in children no subclinical signs of central nervous system impairment and peripheral nervous system as well, can be detected using somatosensory evoked potentials examination.

Screening and diagnosis of diabetes in children and pregnant women

The incidence and prevalence of diabetes in children has increased in recent decades. The findings of a nationwide screening program in Taiwan show that type 2 diabetes has replaced type 1 diabetes as the leading cause of diabetes in children and adolescents. Important risk factors for diabetes in children are high or low birth weights, obesity, and a family history of diabetes. The incidence of diabetes reaches plateaus during puberty. Therefore, we have developed a strategy to screen seventh-grade children with diabetes based on urinalysis and a risk score.Gestational diabetes is associated with various adverse perinatal outcomes, particularly macrosomia and birth injury, and a higher rate of Cesarean section. The 100 g oral glucose tolerance test (OGTT) for gestational diabetes was initially designed to predict maternal diabetes after delivery, and was revised by Carpenter and Coustan to predict adverse fetal outcomes. In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) proposed a 75 g OGTT to define gestational diabetes, resulting in a significant increase in the prevalence of gestational diabetes. Our data suggest that adopting the new IADPSG criteria is reasonable, since they reduce adverse perinatal outcomes and are cost-efficient.

Home urine C-peptide creatinine ratio testing can identify type 2 and MODY in pediatric diabetes

Making the correct diabetes diagnosis in children is crucial for lifelong management. Type 2 diabetes and maturity onset diabetes of the young (MODY) are seen in the pediatric setting, and can be difficult to discriminate from type 1 diabetes. Postprandial urinary C-peptide creatinine ratio (UCPCR) is a non-invasive measure of endogenous insulin secretion that has not been tested as a diagnostic tool in children or in patients with diabetes duration <5 yr. We aimed to assess whether UCPCR can discriminate type 1 diabetes from MODY and type 2 in pediatric diabetes. Two-hour postprandial UCPCR was measured in 264 patients aged <21 yr (type 1, n = 160; type 2, n = 41; and MODY, n = 63). Receiver operating characteristic curves were used to identify the optimal UCPCR cutoff for discriminating diabetes subtypes. UCPCR was lower in type 1 diabetes [0.05 (<0.03-0.39) nmol/mmol median (interquartile range)] than in type 2 diabetes [4.01 (2.84-5.74) nmol/mmol, p < 0.0001] and MODY [3.51 (2.37-5.32) nmol/mmol, p < 0.0001]. UCPCR was similar in type 2 diabetes and MODY (p = 0.25), so patients were combined for subsequent analyses. After 2-yr duration, UCPCR ≥ 0.7 nmol/mmol has 100% sensitivity [95% confidence interval (CI): 92-100] and 97% specificity (95% CI: 91-99) for identifying non-type 1 (MODY + type 2 diabetes) from type 1 diabetes [area under the curve (AUC) 0.997]. UCPCR was poor at discriminating MODY from type 2 diabetes (AUC 0.57). UCPCR testing can be used in diabetes duration greater than 2 yr to identify pediatric patients with non-type 1 diabetes. UCPCR testing is a practical non-invasive method for use in the pediatric outpatient setting.

The emerging landscape of childhood diabetes: unraveling the diagnosis

SUMMARY The diagnosis of diabetes in children has become increasingly complex with the emergence of increased rates of childhood-onset Type 2, monogenic and medication-induced diabetes. Differentiating between different types of childhood diabetes is challenging, requiring a basic understanding of pathophysiology of various diabetes types and their associated clinical risk factors. Overlapping clinical features and conflicting findings on laboratory investigations sometimes complicate the picture. The clinician must pay careful attention to the presence or absence of typical risk factors for Type 2 diabetes, family history of diabetes, laboratory evidence of endogenous insulin production or pancreatic autoimmunity, and the natural progression of the disease, in order to make an accurate diagnosis and choose the most appropriate and effective treatment regimen.

Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review

Objective To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults.Design Systematic review.Data sources PubMed, EMBASE, Web of Science, Scopus, and...

Frequency of Visits Before New Diagnosis of Diabetes in Children

Canadian investigators retrospectively assessed the frequency of medical encounters 1, 2, 3, and 4 weeks before diagnosis of diabetes in children

Missed opportunities?

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

Is Diabetic Ketoacidosis at Disease Onset a Result of Missed Diagnosis?

To determine the frequency of medical encounters before diagnosis of diabetes in children in Ontario, Canada; to determine risk factors for diabetic ketoacidosis (DKA). All medical encounters within 4 weeks before date of diagnosis for all new cases of diabetes in children <18 years were identified from April 1994 to March 2000 by use of administrative databases. The main outcome measure was the frequency of medical encounters before diagnosis in children presenting with and without DKA. A total of 3947 new cases of diabetes were identified, 735 (18.6%) with DKA. DKA rates were 39.7% for children < or =3 years and 16.3% for children >3 years (P < .001). During the week before diagnosis, 285 children with DKA (38.8%) and 1104 children with diabetes without DKA (34.4%; P = .026) had at least 1 medical visit. Children with diabetes overall had more medical encounters before diagnosis than control subjects. Children with DKA were less likely to have had relevant laboratory testing before diagnosis than children with diabetes without DKA. Children with diabetes presenting with DKA more frequently had a medical encounter before diagnosis compared with children with diabetes without DKA. These data have important implications for enhancing public and physician awareness of diabetes in children.

Role of Obesity in Complicating and Confusing the Diagnosis and Treatment of Diabetes in Children

The alarming increase in the prevalence of obesity in children in the United States and globally raises major concerns about its future adverse impact on public health. One outcome of this disturbing trend that is already evident is the rapidly increasing incidence of type 2 diabetes at all ages. This disease, once thought to be nonexistent in children, is increasing coincident with obesity. This article addresses the role that obesity plays in type 2 diabetes and also explores its effects on other types of diabetes that occur in childhood. The new challenges for physicians who formulate a differential diagnosis of diabetes in children are discussed. Also examined are modifications of traditional diabetes treatment that can be helpful in combating the insulin resistance associated with obesity and that use medications that are not traditionally used in this age group. Cases are presented to illustrate certain points. An underlying thesis suggests that specific classification may not be as important to the clinician as the understanding of pathophysiologic factors that contribute to hyperglycemia in individual patients. Recommendations are offered to the practitioner for diagnosing and treating the obese child or adolescent with diabetes.

Height at diagnosis of diabetes in children: a study in identical twins.

The height at diagnosis of 16 insulin dependent diabetics aged under 19 was compared with that of their unaffected identical cotwins measured at the same time. In eight pairs the diabetic was shorter, and in the remainder the cotwins were the same height. In those diabetics who were shorter than their cotwins at diagnosis the average period of growth delay before diagnosis was at least 35 weeks; by contrast, the mean duration of symptoms was only six weeks. No cause for the growth delay other than the diabetes was known in any of the twins. These findings show that the onset of insulin dependent diabetes may be a slow process, with growth delay occurring several months before symptoms appear.