Delayed care for juvenile new-onset typediabetes

Date:
August 23, 2021
Source:
University of Gothenburg
Summary:
Four out of ten children and adolescents who were admitted with
new-onset type 1 diabetes and diabetic ketoacidosis did not receive
hospital treatment the same day as contacts were taken with primary
care. In severe cases, a delay before hospital care begins can
lead to life- threatening conditions.



FULL STORY ==========================================================================
Four out of ten children and adolescents who were admitted with new-onset
type 1 diabetes and diabetic ketoacidosis did not receive hospital
treatment the same day as contacts were taken with primary care. This is
shown in a study from the University of Gothenburg. In severe cases, a
delay before hospital care begins can lead to life-threatening conditions.


==========================================================================
The study, published in the September 2021 issue in the journal Pediatric Diabetes, comprises 237 individuals aged up to 18 with new-onset type
1 diabetes. At some point in the years 2015-17, these children and
adolescents were admitted to hospital in Sweden with acid poisoning
(diabetic ketoacidosis, DKA), a condition that can arise if the patient
does not receive insulin in time.

The study data derive from questionnaires filled out by either parents or
other guardians, jointly with the juveniles if they had reached age 15, or
by hospital care staff. The questionnaires were supplemented with register
data from the Swedish national quality registry for diabetes in children
and adolescents (Swediabkids), part of the National Diabetes Register.

In cases where hospitalization was preceded by contact with primary
care, and where it was feasible to ascertain the course of events,
treatment proved not to have been provided in hospital on the same day,
as guidelines prescribe, in 43 percent (48 of 112) cases.

More knowledge needed A delay in providing emergency hospital treatment,
or its failure to materialize, was also a feature of cases where parents
or guardians had already suspected type 1 diabetes before the first
contact with the care services.

These suspicions were present in 39 percent (92/237) of the cases studied.



========================================================================== Without administration of insulin, patients with type 1 diabetes,
regardless of age, will suffer from diabetic ketoacidosis (DKA) sooner
or later. As the DKA becomes increasingly severe, symptoms -- nausea,
vomiting, and lethargy, for example -- get worse. Eventually, the
condition can lead to loss of consciousness and, at worst, death.

The researchers behind the current study conclude that improved awareness
of the symptoms of new-onset type 1 diabetes and of the importance of
rapid treatment, both among the general population and in primary care,
is necessary.

Hospitalization crucial The study's first author, Dr Johan Wersa"ll,
is a PhD student at Sahlgrenska Academy, University of Gothenburg, and specialist in anesthesia and intensive care at Sahlgrenska University
Hospital.

"Acid poisoning, or diabetic ketoacidosis, is a potentially
life-threatening complication of diabetes that can be entirely avoided if insulin treatment starts in time. So if diabetes is suspected, immediate hospital admission is paramount," he says.

Symptoms to be aware of include bedwetting in a child who has previously
been dry at night, thirst and a need to drink unusually much, fatigue,
nausea, vomiting, abdominal pain, strained breathing, and weight loss.

"Children and adolescents showing symptoms that may be related to
new-onset diabetes should get their blood glucose checked regularly in
primary care.

Where the level is elevated, the patient should be immediately referred
to the nearest pediatric emergency ward," doctor Wersa"ll concludes.

========================================================================== Story Source: Materials provided by University_of_Gothenburg. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Johan H. Wersa"ll, Peter Adolfsson, Gun Forsander, Sven‐Erik
Ricksten, Ragnar Hanas. Delayed referral is common even when
new‐onset diabetes is suspected in children. A Swedish
prospective observational study of diabetic ketoacidosis at onset
of Type 1 diabetes.

Pediatric Diabetes, 2021; 22 (6): 900 DOI: 10.1111/pedi.13229 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210823104311.htm

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