Intended for healthcare professionals

Practice Easily Missed?

Type 1 diabetes in children

BMJ 2011; 342 doi: (Published 16 February 2011) Cite this as: BMJ 2011;342:d294
  1. Keya Ali, consultant paediatrician1,
  2. Anthony Harnden, university lecturer in general practice and general practitioner2,
  3. Julie A Edge, consultant in paediatric diabetes1
  1. 1Oxford Children’s Hospital, John Radcliffe Hospital, Oxford OX3 9DU
  2. 2Department of Primary Health Care, Oxford OX3 7LF
  1. Correspondence to: J A Edge julie.edge{at}

Type 1 diabetes in childhood is one of the commoner long term conditions of childhood. It is treated by specialist teams in secondary care using increasingly intensive insulin regimens, but the onset is generally diagnosed by primary care physicians, sometimes later than is ideal.

Case scenario

A 7 year old boy with acute abdominal pain and vomiting is brought to see his general practitioner by his mother. He was being bullied at school, and because his mother attributed his recent onset of bed wetting to stress she did not mention this symptom to the GP. The GP considers appendicitis a possibility but first decides to rule out a urinary tract infection. A urine dipstick test is positive for glucose and ketones. She refers the child at once to the paediatric team for immediate management of his diabetic ketoacidosis.

How common is it?

  • In England diabetes occurs in 1 in 450 children, of whom 97% have type 1 diabetes mellitus1

  • The current incidence is around 26/100 000 per year

  • In a large UK general practice, a child with new diabetes will be seen about every two years

  • Incidence is increasing by around 4% a year in the UK, in common with other northern European countries2

  • The prevalence of diabetic ketoacidosis at diagnosis over the past 20 years has remained unchanged, at around 25% of newly diagnosed children of all ages and 35% in children under 5 years3 4

Why is it missed?

About 30% of children with newly diagnosed diabetes have had at least one related medical visit before the diagnosis, suggesting that medical practitioners are missing the diagnosis.5 Drinking a lot and …

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