ASSESSMENT OF PHYSICIAN AWARENESS OF THE PRESENTATION OF TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS

Abstract

SUMMERY T his study to assessment of physician awareness to the presentation of type 1 diabetes mellitus (T1DM) in children and adolescents, to assess the possible misdiagnosis of presentation of T1DM in children and adolescents, to assess the time for children and adolescents needed from presentation till a diagnosis of T1DM and to asses impact of time needed for diagnosis and presentation with diabetic ketoacidosis (DKA). A structured questionnaires were used, they were directed to 60 doctors dealing with children and adolescents (general practitioner, pediatric resident and pediatrician) and 200 diabetic patients following up at the diabetes clinic or their parents. The doctors questionnaire test their knowledge of all inclusion of screening for T1DM in conditions that are possible differential diagnosis, presenting symptoms of T1DM, prevalence and trend of T1DM in Egypt and by generally test their knowledge about T1DM. The patient questionnaire including the presentation history (emergency and non emergency), family history, number of physicians examining the patient before the diagnosis was made, time and duration between the development of the first symptoms and getting the final diagnosis, development of acute complications in the form of DKA and percent of patients diagnosed with DKA, duration of hospital admission at diagnosis in relation to the various presentations and the time to diagnosis and test their knowledge about T1DM. After statistical analysis of the collecting data from all questionnaires and studying of the results we found the following about doctors: • More included doctors were pediatricians (46.7%). • Most of included doctors (46.6%) have 2-3 years duration of practice and mean of 5.93±5.78 years. • Most of included doctors(81.67%) included DM in differential diagnosis if the child presents with vomiting, 100% if the child presents with polyuria, 65% if the child presents with SOB, 73.33% if child presents with abdominal pain and 76.67% of doctors exclude DM if child presents with nocturnal enuresis. • Most of included doctors (88.3%) knows that the prevalence of T1DM in Egypt is rising. • Most of included doctors (80%) considered that DKA is always the presentation of T1DM in children. • Most doctors give correct answers regarding T1DM presentation and family history but 43.3% of them consider that it is best treated with premixed insulins. • About half of doctors (48.3%) have seen patients that diagnosed as diabetes but were proved later to have T1DM. • Neither the specialty or duration of practice were significant in affecting doctor awareness of T1DM.

And found the following about patients: • The mean patients' age was 11.34 ± 4.36 years, patient sex (60% female&40% male), and mean duration of DM was 4.45 ± 3.54 years. • Fifty six percent (56%) of patients have family history of diabetes. • About half (49.5%) of all studied patients were older than 12 years of age. • Almost half of patients (48.5%) were diagnosed between >6-12 years old. • Most of our patients had duration of DM of 2-6 years followed by those <2 years then those with a duration of >6-12 years. • Most common symptoms at DM presentation was weight loss. • Ninety seven and half percent (97.5%) of patients had hospital admission and 18.5% only were admitted in intensive care unit (ICU). • Most of admitted cases (56.92%) presented with diabetic ketoacidosis (DKA). • Mean duration of hospital admission was about 15.18 days per patient, increased with patients aged (< 2 years) at diagnosis and decreased in (>6-12 years) category. • The mean duration between presentation and diagnosis was 21.32±10.75 days, increased with patients aged (>12 years) at diagnosis and decreased in (2-6 years) category. • There is no significance for family history in length of duration between presentation and diagnosis of DM. • One hundred and forty (140) cases (70%) needed 1 doctor to be diagnosed and 60 cases(30%) needed more than 1 doctor(a mean of 1.50±0.33 doctor). • Fifty six percent (56%) of patients were seen by pediatricians and most of those who misdiagnosed them at first presentation were 50% pediatricians and 26% were internists. • Most patients (40%) who needed more than one doctor were aged >6 -12 years at diagnosis and 60% of patients aged <2 years at diagnosis were misdiagnosed. • Twenty seven (27%) of misdiagnosed cases were diagnosed as gastroenteritis. • Sixty four and half (64.5%) of patients experienced DKA attacks (at presentation and after that) and increased in patients aged > 12 years. • Most of patients experienced in DKA attacks > 2 - 6 years duration of DM. • Ninety seven and half percent (97.5%) of patients know that cases of DM in children in Egypt is increasing. • Most of patients think that the cause of DM is either hereditary or 2ry to infection. • Most of patients consider that the associated complication to T1DM mainly on eye, kidney, heart and 83.50% consider diabetic foot as one of the main complications • Ninety two percent (92%) of patients see that good control may prevent the Complications of DM.