title: Difficulties or mistakes in diagnosing type 1 diabetes mellitus in children? The consequences of delayed diagnosis.
abstract: BACKGROUND
  Delayed diagnosis is one of the causes of diabetic ketoacidosis (DKA) development in many children with new-onset of type 1 diabetes mellitus (T1DM).
  
  
  OBJECTIVE
  of the study was to analyse difficulties in diagnosing T1DM and establish if delayed recognition is the main risk factor of diabetic ketoacidosis (DKA) in children with newly diagnosed T1DM.
  
  
  METHODS
  Retrospective analysis of 335 children with new-onset T1DM, aged below 17 years and living in the Pomeranian region of Poland, was carried out. The delay in diagnosis was recognized if the patient was not diagnosed on the first visit because of omission, wrong interpretation of symptoms, exclusive treatment of additional diabetic signs or concomitant diseases.
  
  
  RESULTS
  Difficulties in diagnosing T1DM were found in 54 cases (16.12%). The initial diagnosis was wrongly categorized as respiratory system infection (46.3%), perineal candidiasis (16.6%), gastroenteritis (16.6%), urinary tract infection (11.1%), stomatitis (11.1%), appendicitis (3.7%). Duration of symptoms (mean 14 days) and glycated haemoglobin level did not significantly correspond with diagnostic delay. DKA was significantly more frequent in children with delayed diagnosis - 33 patients (61.11%) (p=0.0005). The infection preceding diagnosis of T1DM, more common among children with delayed recognition, did not affect the duration of symptoms or affect characteristicly more frequent DKA development in children with diagnostic delay.
  
  
  CONCLUSIONS
  No significant associations between diagnostic delay and duration of diabetic symptoms as well as glycated haemoglobin level exclude possibility of delayed diagnosis because of slow development of diabetic symptoms. Significantly more frequent DKA development in children with delayed recognition, irrespective of infection preceding diagnosis, and no confirmation that younger patient's age predisposes to quick increase of DKA point out that the main risk factor for DKA development in the research group was diagnostic delay.
authors.affiliation: The Clinic of Paediatrics, Hematology and Oncology and Endocrinology, Medical University, Gdansk.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Pawłowicz
authors.forename: Dorota
authors.initials: D
authors.lastname: Birkholz
authors.forename: Maciej
authors.initials: M
authors.lastname: Niedźwiecki
authors.forename: Anna
authors.initials: A
authors.lastname: Balcerska
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors