Delayed care for juvenile new-onset type 1 diabetes

[Northerner]

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.

Delayed care for juvenile new-onset type 1 diabetes

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.

www.sciencedaily.com

 

[mikeyB]

And this is interesting because…..?

It’s not like you, Northie, to use a Clickbait headline like that.

 

[Thebearcametoo]

I think it’s always worth reviewing the gap between good/best practice and reality. My daughter’s diagnosis from when she actually saw the GP was straight to the hospital and onto the paediatric ward to begin treatment but the GP appointment was delayed because when I said I wanted to see a doctor because I was worried my daughter might have diabetes I was given an appointment for a week later. I didn’t know that that wasn’t normal and neither did the receptionist (in covid times because of how the appointment system has changed it would actually be dealt with the same day) so these sorts of stories matter because the more people who know what should be happening the more likely it is that fewer cases will fall through the gaps ‍♀️

 

[trophywench]

Is the inference that this happens in the UK too? - I mean we know it does happen sometimes - but surely not when it's a child? Or is it more with stroppy teenagers?

 

[Northerner]

Is the inference that this happens in the UK too? - I mean we know it does happen sometimes - but surely not when it's a child? Or is it more with stroppy teenagers?

It definitely happens here, and to children - several of our members have been in this unfortunate position

 

[trophywench]

Oh - 'eck. Last year No 2 daughter was sorely tempted to ring up and say her 8yo was ill when she was and couldn't get an appt - cos even our surgery (where it was dire) was still seeing the little 'uns asap.

 

[Sally71]

Yep, it happens here. I will always regret not taking my daughter to the doctor sooner, but when I finally knew she was definitely ill and I wasn’t imagining it I rang to make an appointment and was told by the receptionist “well that’s not urgent is it” and made an appointment for 2 days later. GP seemed unconvinced that there was anything seriously wrong as “she’s not in DKA” and wanted to send us home again, urine test was apparently normal, luckily he realised that he wouldn’t be doing his job properly if he didn’t check out the symptoms I described so ordered blood tests. Unfortunately he said it should be a fasting blood test and there were no appointments available until the following Monday, 5 days later. I wanted to say that we don’t want to wait for her to go into DKA, but wasn’t really familiar with what that is and didn’t know enough about it to argue, also the decline in her health had been slow up to that point so I thought a few extra days wouldn’t make much difference. They did though, she started to go downhill very fast and when we finally got the blood test done she was hardly eating any food at all because nothing tasted right and was getting weaker by the minute. The next day, GP surgery opened at 8am and we got a phone call at 8.05 asking us to get her back in at 11, that was the longest 3 hours of my life. Turns out her fasting BG was 18, finger prick done then was off the scale and urine now full of sugar and ketones. By that point daughter could barely stand up never mind walk, so it was not a surprise to me, GP looked like he’d had the shock of his life though, especially as she was now showing clear signs of DKA less than a week after he saw her the first time. Straight to hospital then, lab BG came back at 46 and consultant said she probably would have been unconscious within a day if we hadn’t got her into hospital then. DSNs said that GPs see almost all type 2s so they tend to base all their diabetes knowledge on that (fasting test is correct for diagnosing type 2), whereas what they should do when faced with a young child with diabetes symptoms is just do a finger prick and then send them straight to hospital if it comes out anywhere above normal.

That particular GP moved on not long afterwards, but there is another GP there who I found out used to work in a paeds diabetes hospital team before she went into general practice, if only we’d had her that day things might have been very different

 

[Thebearcametoo]

Yep, it happens here. I will always regret not taking my daughter to the doctor sooner, but when I finally knew she was definitely ill and I wasn’t imagining it I rang to make an appointment and was told by the receptionist “well that’s not urgent is it” and made an appointment for 2 days later. GP seemed unconvinced that there was anything seriously wrong as “she’s not in DKA” and wanted to send us home again, urine test was apparently normal, luckily he realised that he wouldn’t be doing his job properly if he didn’t check out the symptoms I described so ordered blood tests. Unfortunately he said it should be a fasting blood test and there were no appointments available until the following Monday, 5 days later. I wanted to say that we don’t want to wait for her to go into DKA, but wasn’t really familiar with what that is and didn’t know enough about it to argue, also the decline in her health had been slow up to that point so I thought a few extra days wouldn’t make much difference. They did though, she started to go downhill very fast and when we finally got the blood test done she was hardly eating any food at all because nothing tasted right and was getting weaker by the minute. The next day, GP surgery opened at 8am and we got a phone call at 8.05 asking us to get her back in at 11, that was the longest 3 hours of my life. Turns out her fasting BG was 18, finger prick done then was off the scale and urine now full of sugar and ketones. By that point daughter could barely stand up never mind walk, so it was not a surprise to me, GP looked like he’d had the shock of his life though, especially as she was now showing clear signs of DKA less than a week after he saw her the first time. Straight to hospital then, lab BG came back at 46 and consultant said she probably would have been unconscious within a day if we hadn’t got her into hospital then. DSNs said that GPs see almost all type 2s so they tend to base all their diabetes knowledge on that (fasting test is correct for diagnosing type 2), whereas what they should do when faced with a young child with diabetes symptoms is just do a finger prick and then send them straight to hospital if it comes out anywhere above normal.

That particular GP moved on not long afterwards, but there is another GP there who I found out used to work in a paeds diabetes hospital team before she went into general practice, if only we’d had her that day things might have been very different

Wow that’s scary. Ours thankfully did a finger prick and then phoned the ward immediately and got her admitted but again the receptionist was not in any hurry so it was a week later than it might have been. I must write to the surgery and mention that as it seems to be not uncommon. I know they will mostly see people for type 2 but ‘I think my child might be diabetic’ should mean they’re seen urgently.