title: The pathway to diagnosis of type 1 diabetes in children: a questionnaire study.
abstract: OBJECTIVE
  To explore the pathway to diagnosis of type 1 diabetes (T1D) in children.
  
  
  METHODS
  Questionnaire completed by parents.
  
  
  METHODS
  Parents of children aged 1 month to 16 years diagnosed with T1D within the previous 3 months.
  
  
  METHODS
  Children and parents from 11 hospitals within the East of England.
  
  
  RESULTS
  88/164 (54%) invited families returned the questionnaire. Children had mean±SD age of 9.41±4.5 years. 35 (39.8%) presented with diabetic ketoacidosis at diagnosis. The most common symptoms were polydipsia (97.7%), polyuria (83.9%), tiredness (75.9%), nocturia (73.6%) and weight loss (64.4%) and all children presented with at least one of those symptoms. The time from symptom onset to diagnosis ranged from 2 to 315 days (median 25 days). Most of this was the appraisal interval from symptom onset until perceiving the need to seek medical advice. Access to healthcare was good but one in five children presenting to primary care were not diagnosed at first encounter, most commonly due to waiting for fasting blood tests or alternative diagnoses. Children diagnosed at first consultation had a shorter duration of symptoms (p=0.022) and children whose parents suspected the diagnosis were 1.3 times more likely (relative risk (RR) 1.3, 95% CI 1.02 to 1.67) to be diagnosed at first consultation.
  
  
  CONCLUSIONS
  Children present with the known symptoms of T1D but there is considerable scope to improve the diagnostic pathway. Future interventions targeted at parents need to address the tendency of parents to find alternative explanations for symptoms and the perceived barriers to access, in addition to symptom awareness.
authors.affiliation: The Primary Care Unit, University of Cambridge, Cambridge, UK.
authors.forename: Juliet A
authors.identifier: http://orcid.org/0000-0002-8501-2531
authors.initials: JA
authors.lastname: Usher-Smith
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thompson
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Zhu
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.affiliation: The Primary Care Unit, University of Cambridge, Cambridge, UK.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D053158:Nocturia / Q000453:epidemiology*; D010290:Parents / Q000193:education / Q000523:psychology*; D059606:Polydipsia / Q000453:epidemiology*; D011141:Polyuria / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss
keywords: PRIMARY CARE