A Missed Type 1 Diabetes Diagnosis Increases Risk of Diabetic Ketoacidosis by 18%

A Missed Type 1 Diabetes Diagnosis Increases Risk of Diabetic Ketoacidosis by 18%

-Craig Idlebrook

A new study of more than 2,500 people with type 1 diabetes chronicles how frequently type 1 diabetes is misdiagnosed, and how potentially dangerous a missed diagnosis can be.

The study, conducted by T1D Exchange Patient-Centered Research team and others, found that one in four people with type 1 diabetes was initially misdiagnosed with another medical condition, and that this misdiagnosis was associated with an 18% increased risk of potentially deadly diabetic ketoacidosis (DKA). The findings were published in May for Clinical Diabetes.

For the study, researchers recruited people with type 1 diabetes and caregivers of children with type 1 diabetes to answer questions about an initial diagnosis of type 1 diabetes. They then analyzed the answers from just over 2,500 completed questionnaires.

The researchers found that those diagnosed with type 1 diabetes as adults had very different experiences than those diagnosed as children, and that too often a missed diagnosis put children at risk of DKA.

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Here were some key findings from the study, in addition to the figures cited above:

-Children and adults often exhibited different symptoms before diagnosis. Participants diagnosed during childhood said they experienced excessive thirst, frequent urination, and flu-like symptoms, among other symptoms. Meanwhile, those diagnosed as adults reported blurred vision, delayed healing of sores, tingling hands and feet, changes in gums, and urinary tract infections, among other symptoms.

-Children who were misdiagnosed were most often given an initial diagnosis of a viral infection or flu, whereas adults who were misdiagnosed were most likely to receive a type 2 diabetes diagnosis.

-The rate of misdiagnosis was much higher for those diagnosed as adults (39%) versus those who were diagnosed as children (16%).

-Some 68% of participants who were misdiagnosed as children experienced DKA, whereas only 43% of children who received the correct diagnosis the first time experienced DKA.

-The rate of DKA was the same among adults who were initially misdiagnosed and those who received the correct initial determination.

“Such findings are troubling,” said Colleen Garey, MS, a data analyst at T1D Exchange, “given how severely DKA can impact the health of people with type 1 diabetes. DKA at diagnosis is associated with higher initial HbA1c levels and increased impairment of beta cell function. It is also the leading cause of death in children and young adults with type 1 diabetes.”

“Primary care providers and hospital physicians should be aware of the initial symptoms of type 1 diabetes as they are the first line of defense,” said Garey. “Type 1 diabetes should be considered if a child or adult is presenting any symptoms with the hope of lowering the incidence of DKA at diagnosis.”


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