Misdiagnosis of T1D is common and raises DKA risk in children

  • Muñoz C & al.
  • Clin Diabetes
  • 01.07.2019

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • 1 in 4 patients with new-onset type 1 diabetes (T1D) is initially misdiagnosed. 
  • Misdiagnosis is associated with an 18% increased risk for diabetic ketoacidosis (DKA) in children.
  • Providers should consider T1D in adults with new-onset diabetes, and T1D should be ruled out in children with nonspecific viral symptoms.

Why this matters

  • DKA is a life-threatening condition.
  • T1D requires immediate insulin treatment.

Study design

  • Retrospective online survey of 2526 adults with T1D or parents of children with T1D, from the T1D Exchange.
  • Funding: T1D Exchange.

Key results

  • Initial misdiagnosis was reported by 24% overall, and by 16% of those
  • In adults, the wrong diagnosis most often was type 2 diabetes (76.8%), while in children it was influenza/other viral infection (53.7%). 
  • At diagnosis, 66.1% were hospitalized, and 40.9% experienced DKA.
  • Patients with misdiagnosed T1D were at 17.6% increased risk for DKA compared with those correctly diagnosed at onset (45.2% vs 38.4%; P<.05>
  • In children, DKA occurred in 68% initially misdiagnosed vs 42.8% correctly diagnosed (P<.001 but no difference among adults.>

Limitations

  • Retrospective self-reported data, possible ascertainment and recall biases.
  • Online respondents may not generally represent the overall T1D population.