Children with undiagnosed type 1 diabetes ‘at great risk’

By Editor
14th July 2017
Audits, Paediatrics

Children aged five and under who are not diagnosed with type 1 diabetes fast enough are at the greatest risk of death, new figures have suggested.

According to the 2017 National Paediatric Diabetes Audit, one in four children in the UK only find out they have the chronic condition when they are admitted to hospital with a life-threatening complication.

The report, which is published by the Royal College of Paediatrics and Child Heath (RCPCH), maps out how the rise of type 1 diabetes incidence among children is causing a significant increase in paediatric type 1 diabetes hospital admissions.

This report shows that too many children are developing diabetic ketoacidosis, which is often down to a lack of understanding of the symptoms of type 1 diabetes

The audit’s results are based on data collected from between 2012 and 2015 relating to children and young people in paediatric day units in England and Wales, with any type of diabetes. Type 1 diabetes accounts for the vast majority of cases of diabetes in children. Incidence of type 1 diabetes in the UK is growing particularly in children under five.

The findings suggested the number of children who were admitted to hospital for diabetic ketoacidosis (DKA) due to late diagnosis occurred in 23 er cent of new cases of young people with type 1 diabetes.

Diagnosis period

The report also found that nearly a quarter of children and young people living with type 1 diabetes were admitted to hospital for reasons related to their condition, within each audit year between 2012 and 2015. A total of 40 per cent of admissions over the three year period were within the first year of diagnosis, including cases of DKA at diagnosis.

Of the nearly 30,000 UK children living with type 1 diabetes, girls and young women and those from deprived backgrounds are at most risk of being hospitalised with DKA.

Beyond their diagnosis period, females were at 33 per cent increased risk of admission with DKA compared to males.

The report also found that children up to the age of four and those living in deprived areas had higher rates of hypoglycaemia (dangerously low blood glucose levels, also known as ‘having a hypo’). Children and young people in the least deprived areas had a 42 per cent lower risk of admission with hypoglycaemia compared with those in the most deprived areas.

Karen Addington, UK chief executive of the type 1 diabetes charity JDRF said: “This report shows that too many children are developing diabetic ketoacidosis, which is often down to a lack of understanding of the symptoms of type 1 diabetes. It is crucial that type 1 diabetes is identified early, to reduce the risk of DKA at diagnosis.

“To ensure diagnoses take place earlier we need to develop a greater understanding among both the public and healthcare professionals of the symptoms of type 1: increased thirst, going to the toilet often, tiredness, blurred vision and sudden weight loss.”

German researchers have been looking at whether introducing new standards for early diagnosis in a region of Germany can reduce the region’s rates of DKA at diagnosis.

The Frida trial is adding into the regular schedule of early years check-ups a blood test to screen for type 1 diabetes. The test shows whether a child is likely to go on to develop the condition by identifying autoantibodies produced by the immune system to drive the attack on the insulin-producing beta cells. For any person with one or more of these autoantibodies in their blood, their risk of developing type 1 diabetes within five years of that test is 51 per cent, rising to 75 per cent in 10 years, and nearing 100 per cent over their lifetime.

Any children who test positively for an autoantibody are invited, with their families, to take part in educational sessions about type 1 diabetes, including how to recognise the early symptoms.

In May 2016, the study team reported that in the first 12 months of the study, 26,760 children had been tested for the predictors of type 1 diabetes, with 63 of those children testing positive. Almost all of the affected families took up the offer of educational sessions, and at the time of reporting, none of the children involved had experienced DKA.

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