Klinische presentatie van kinderen met diabetes mellitus type 1 ten tijde van de diagnosestelling

Objective. Identification of presenting symptoms and risk factors for development of diabetic ketoacidosis (DKA) and evaluation of the diagnostic pathway taken with new-onset diabetes mellitus type 1 (DM1). Design. Retrospective study. Methods. 81 children diagnosed with DM1 from January 1999 to September 2006 in the Diakonessenhuis location Utrecht/Zeist were included. Symptoms and laboratory results were studied. A questionnaire was sent to patients, parents and referring general practitioner (GP) addressing the elapsed time between occurrence of symptoms and first visit to GP (patient's delay in days (PD)), the diagnostic pathway taken by GP and elapsed time until referral (doctor's delay in hours (DD)). Results. DKA was found in 13/81 patients (16%). Incidence did not differ between different age groups. Besides classic symptoms of DM1, recurrent candidiasis and renewed bedwetring were frequendy observed. PD and DD were not significantly correlated with age at diagnosis. No relationship was observed between incidence and severity of DKA, and age at diagnosis and presence and severity of DD. PD was significantly shorter in children with DKA. HbA_1C was significantly correlated with both age at diagnosis and degree of PD. A significant difference was observed in presence and degree of DD between diagnostic tests. Conclusion. In our study region we observed no increased risk of DKA in young children possibly indicating adequate medical awareness. Extrapolation to national data however, is difficult and should therefore plea in favour of a national registry. In young children, intrinsic factors might be associated with more rapid metabolic decompensation. Besides well-known classic symptoms, recurrence of bedwetting and recurrent candidiasis should arouse suspicion on DM1. Assessment of a random serum glucose is recommended whenever DM1 is suspected.