| Institution: | 1. Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK;2. Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 89195-4596, USA;3. The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK |
| Abstract: | BackgroundThe epidemiology of type 1 diabetes mellitus (T1DM) suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis. We sought to quantify opportunities for earlier diagnosis of T1DM in primary care.MethodsA matched case-control study of children (0–16 years) presenting to UK primary care, examining routinely collected primary care consultation types and National Institute for Health and Care Excellence (NICE) warning signs in the 13 weeks before diagnosis.ResultsOur primary analysis included 1920 new T1DM cases and 7680 controls. In the week prior to diagnosis more cases than controls had medical record entries (663, 34.5% vs 1014, 13.6%, odds ratio 3.46, 95% CI 3.07–3.89; p < 0.0001) and the incidence rate of face-to-face consultations was higher in cases (mean 0.32 vs 0.11, incidence rate ratio 2.90, 2.61–3.21; p < 0.0001). The preceding week entries were found in 330 cases and 943 controls (17.2% vs 12.3%, OR 1.49, 1.3–1.7, p < 0.0001), but face-to-face consultations were no different (IRR 1.08 (0.9–1.29, p = 0.42)).InterpretationThere may be opportunities to reduce time to diagnosis for up to one third of cases, by up to two weeks. Diagnostic opportunities might be maximised by measures that improve access to primary care, and public awareness of T1DM. |
