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Presentation to primary care during the prodrome of type 1 diabetes in childhood: a case control study using record data linkage

Presentation to primary care during the prodrome of type 1 diabetes in childhood: a case control study using record data linkage
Presentation to primary care during the prodrome of type 1 diabetes in childhood: a case control study using record data linkage
Objective: to evaluate primary care presentations during the prodrome (12 months prior to onset type‐1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis. Methods: his was a case‐control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA. Results: a total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047). Conclusion: there are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA.
1399-543X
330-338
Townson, Julia
bbbf583d-fd5e-4750-b3dc-02b7f2dac204
Cannings-John, Rebecca
f45c9562-b1d0-4c6d-9c7c-8f27cd3e47cd
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Thayer, Dan
c4dec024-450c-4cf0-8ced-eb20a1605a0e
Gregory, John
d8d05813-2a1d-484c-9c73-2baa71526ca3
Townson, Julia
bbbf583d-fd5e-4750-b3dc-02b7f2dac204
Cannings-John, Rebecca
f45c9562-b1d0-4c6d-9c7c-8f27cd3e47cd
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Thayer, Dan
c4dec024-450c-4cf0-8ced-eb20a1605a0e
Gregory, John
d8d05813-2a1d-484c-9c73-2baa71526ca3

Townson, Julia, Cannings-John, Rebecca, Francis, Nick, Thayer, Dan and Gregory, John (2019) Presentation to primary care during the prodrome of type 1 diabetes in childhood: a case control study using record data linkage. Pediatric Diabetes, 20 (3), 330-338. (doi:10.1111/pedi.12829).

Record type: Article

Abstract

Objective: to evaluate primary care presentations during the prodrome (12 months prior to onset type‐1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis. Methods: his was a case‐control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA. Results: a total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047). Conclusion: there are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA.

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Accepted/In Press date: 28 January 2019
e-pub ahead of print date: 9 February 2019
Published date: 1 May 2019

Identifiers

Local EPrints ID: 435560
URI: http://eprints.soton.ac.uk/id/eprint/435560
ISSN: 1399-543X
PURE UUID: 3517017b-66e5-4190-8135-e773a5787982
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 11 Nov 2019 17:30
Last modified: 29 Oct 2023 03:19

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Contributors

Author: Julia Townson
Author: Rebecca Cannings-John
Author: Nick Francis ORCID iD
Author: Dan Thayer
Author: John Gregory

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