Lack of awareness of diabetes in young children is putting lives at risk

The findings of a new study carried out by doctors in Southampton and Oxford suggest that UK health professionals are failing to recognise the symptoms of type 1 diabetes in children and that this is putting children's lives at risk.

Dr Justin Davies, a consultant paediatric endocrinologist at Southampton Children's Hospital, said a lack of awareness meant patients were being sent to multiple clinicians, having unnecessary investigations, missing out on crucial finger-prick blood tests and, ultimately, receiving misdiagnoses.

When treatment with insulin is delayed, patients with type 1 diabetes are at increased risk of a potentially fatal complication called diabetic ketoacidosis (DKA), which occurs when the body starts to break down fat in the absence of insulin.

DKA is present in 25% of the 2,000 children newly diagnosed with type 1 diabetes annually in the UK and is responsible for ten deaths a year.

"Despite improvements in diabetes care leading to increased life expectancy, the mortality rate for children with type 1 diabetes remains higher than the general population and DKA is the leading cause of death," explained Dr Davies.

"Unfortunately, the incidence of DKA in a quarter of patients at diagnosis is relatively unchanged from reports over the past 20 years and nearly twice as high as that observed in Sweden. This is a major concern."

In the largest study of its kind researchers examined the symptoms in the lead up to the diagnosis of type 1 diabetes in 261 children aged between eight months and 16 years at 75 hospitals in England, Wales and Northern Ireland.

Dr Davies said while a quarter of all children presented with DKA at diagnosis of type 1 diabetes, the results showed a "worrying tendency" to overlook the possibility of diabetes in children under two, with more than three-quarters (80%) affected by DKA at diagnosis compared to just 23% in older children.

A third of all children with DKA had seen multiple health professionals before the diagnosis was made, but the proportion rose to more than two-thirds (69%) in children under the age of two, largely because they often lacked the classical symptoms of going to the toilet more frequently, bed-wetting and excessive thirst.

Dr Kemi Lokulo-Sodipe, a research fellow at Southampton Children's Hospital and co-author of the study, said there was a "specific and desperate need" to increase public and professional awareness that diabetes does occur in very young children and what to look for in this age group.

"As a nation, we need to emphasise that diabetes is common and the incidence is increasing," she explained.

"It can present in babies and young children and it should be at the top of the list in any child with increased toileting - including heavy wet nappies and bedwetting, but also weight loss and fatigue.

"When symptomatic children with undiagnosed type 1 diabetes had multiple contacts with health professionals, they were more likely to present with DKA and this is very concerning as we know early diagnosis is essential to enable treatment with insulin and avoid complications."

Dr Julie Edge, a consultant in paediatric diabetes at Oxford Children's Hospital, added: "The diagnosis of diabetes can be made very quickly with a finger-prick test of blood glucose level and no other investigations are necessary.

"All parents should ask for this to be done at the first presentation to their GP if they believe their child may have diabetes and, once diagnosed, children should be referred on the same day to the local children's diabetes team."

The study is published in the journal Archives of Disease in Childhood

A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
A condition that is linked to, or is a consequence of, another disease or procedure. Full medical glossary
A disorder caused by insufficient or absent production of the hormone insulin by the pancreas, or because the tissues are resistant to the effects. Full medical glossary
Condition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. Full medical glossary
The process of determining which condition a patient may have. Full medical glossary
An abbreviation for diabetic ketoacidosis. Full medical glossary
One of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. Full medical glossary
The basic unit of genetic material carried on chromosomes. Full medical glossary
An organ with the ability to make and secrete certain fluids. Full medical glossary
A simple sugar that is an important source of energy in the body. Full medical glossary
The number of new episodes of a condition arising in a certain group of people over a specified period of time. Full medical glossary
A hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. Full medical glossary
High acidity of the blood and tissues combined with high levels of ketones in the blood. Ketones are produced during the breakdown of fat. Full medical glossary