The pathway to diagnosis of type 1 diabetes in children: a questionnaire study.
The pathway to diagnosis of type 1 diabetes in children: a questionnaire study.
复制标题
DOI：
10.1136/bmjopen-2014-006470
复制
发表时间：
2015-03-17
期刊：
影响因子：
2.9
通讯作者：
Walter FM
中科院分区：
文献类型：
--
作者：
Usher-Smith JA;Thompson MJ;Zhu H;Sharp SJ;Walter FM
探讨儿童1型糖尿病（T1 D）的诊断途径。家长填写的问卷。1个月至16岁儿童的父母在过去3个月内被诊断患有T1 D。 来自英格兰东部11家医院的儿童和家长。88/164（54%）的受邀家庭返回了问卷。儿童的平均±SD年龄为9.41±4.5岁。 35例（39.8%）在诊断时出现糖尿病酮症酸中毒。最常见的症状是多饮（97.7%），多尿（83.9%），疲倦（75.9%），肥胖（73.6%）和体重减轻（64.4%），所有儿童都表现出至少一种这些症状。从症状发作到诊断的时间范围为2至315天（中位数25天）。 其中大部分是从症状发作到认为需要寻求医疗建议的评估间隔。获得医疗保健的机会很好，但五分之一的儿童在第一次就诊时没有被诊断出来，最常见的原因是等待空腹血液检查或其他诊断。在第一次咨询时诊断的儿童症状持续时间较短（p=0.022），父母怀疑诊断的儿童在第一次咨询时被诊断的可能性高1.3倍（相对风险（RR）1.3，95% CI 1.02至1.67）。儿童存在T1 D的已知症状，但有相当大的空间来改善诊断途径。今后针对父母的干预措施需要解决父母除了对症状的认识之外，还倾向于为症状和感知到的获取障碍寻找其他解释的问题。
To explore the pathway to diagnosis of type 1 diabetes (T1D) in children. Questionnaire completed by parents. Parents of children aged 1 month to 16 years diagnosed with T1D within the previous 3 months. Children and parents from 11 hospitals within the East of England. 88/164 (54%) invited families returned the questionnaire. Children had mean±SD age of 9.41±4.5 years. 35 (39.8%) presented with diabetic ketoacidosis at diagnosis. The most common symptoms were polydipsia (97.7%), polyuria (83.9%), tiredness (75.9%), nocturia (73.6%) and weight loss (64.4%) and all children presented with at least one of those symptoms. The time from symptom onset to diagnosis ranged from 2 to 315 days (median 25 days). Most of this was the appraisal interval from symptom onset until perceiving the need to seek medical advice. Access to healthcare was good but one in five children presenting to primary care were not diagnosed at first encounter, most commonly due to waiting for fasting blood tests or alternative diagnoses. Children diagnosed at first consultation had a shorter duration of symptoms (p=0.022) and children whose parents suspected the diagnosis were 1.3 times more likely (relative risk (RR) 1.3, 95% CI 1.02 to 1.67) to be diagnosed at first consultation. Children present with the known symptoms of T1D but there is considerable scope to improve the diagnostic pathway. Future interventions targeted at parents need to address the tendency of parents to find alternative explanations for symptoms and the perceived barriers to access, in addition to symptom awareness.
登录
查看更多内容
影响因子：
5.4
作者：
ANDERSEN, BL;CACIOPPO, JT;ROBERTS, DC
通讯作者：
ROBERTS, DC
影响因子：
1.8
作者：
Blanc, N;Lucidarme, N;Tubiana-Rufi, N
通讯作者：
Tubiana-Rufi, N
影响因子：
0.4
作者：
Kapellen, TM;Galler, A;Kiess, W
通讯作者：
Kiess, W
影响因子：
8.8
作者：
Forbes, L. J. L.;Simon, A. E.;Wardle, J.
通讯作者：
Wardle, J.
影响因子：
8.2
作者：
Fredheim, S.;Johannesen, J.;Svensson, J.
通讯作者：
Svensson, J.