Original ArticleIs Diabetic Ketoacidosis at Disease Onset a Result of Missed Diagnosis?
Section snippets
Methods
Data sources included: (1) the Ontario Health Insurance Plan (OHIP), which includes information pertaining to health services provided by Ontario physicians; (2) the Registered Persons Data Base of the Ontario Ministry of Health and Long-Term Care, which provides information about individuals registered for OHIP such as their health care number, surname, date of birth, sex, address, and date of death, if applicable; and (3) the Canadian Institutes for Health Information Discharge Abstract
Results
We identified a total of 3947 new cases of diabetes in Ontario children during the study period. With 1996 census data16 we calculated an approximate average annual incidence of 29.7 new cases per 100 000 children, similar to that reported previously for this region in the same period.17, 18 Of these, 735 patients presented with DKA, representing 18.6% of the total study population. The incidence of diabetes increased on average by 4.3% per year. The proportion of children presenting with DKA
Discussion
Our index case detection algorithm was based on a method described by Blanchard et al.19 Because the prevalence of diabetes is relatively low in children as compared with the adults, it is possible that our algorithm detected some false-positive cases, which would produce a lower detected DKA rate. This is likely to be a small effect in our study. Hux et al17 found that inclusion of any CIHI records of hospitalization in the algorithm led to a decrease in specificity to 94%, presumably because
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OUTCOMES OF MISSED DIAGNOSIS OF PEDIATRIC APPENDICITIS, NEW-ONSET DIABETIC KETOACIDOSIS, AND SEPSIS IN FIVE PEDIATRIC HOSPITALS
2023, Journal of Emergency MedicineImpact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries
2022, The Lancet Diabetes and EndocrinologyCitation Excerpt :From the onset of hyperglycaemia, progression to diabetic ketoacidosis usually occurs over a period of several days to weeks.2 Therefore, diabetic ketoacidosis at the time of diagnosis of type 1 diabetes suggests delayed diagnosis of diabetes and commencement of insulin treatment.6,7 Delayed referral for new-onset type 1 diabetes might be due to parents' and caregivers' inadequate knowledge of the symptoms of diabetes, or due to non-recognition of the signs of diabetes early in children presenting to primary health care.6–8
Diabetic ketoacidosis in pediatric patients with type 1- and type 2 diabetes during the COVID-19 pandemic
2021, Metabolism: Clinical and ExperimentalEndocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review
2023, Journal of Clinical Medicine
Supported by the Institute for Clinical Evaluative Sciences, an independent non-profit organization funded by the Ontario Ministry of Health and Long-Term Care, with provision of population-based data. H.B. was supported by a fellowship award from the Canadian Pediatric Endocrine Group (CPEG), the national professional pediatric endocrinology association. T.T. is supported by the Dales Award, University of Toronto, and D.D. by the RS McLaughlin Foundation Chair in Paediatrics. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The opinions, results and conclusions are those of the authors and no endorsement by the Ontario Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. The authors declare no conflicts of interest.