medwireNews: Children are less likely to present with diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis if they previously had regular access to a healthcare provider, research published in CMAJ suggests.
The association was statistically significant only for children aged 12–17 years, however. Among this age group, having seen a primary care practitioner or pediatrician at least twice between 2 years and 7 days before diabetes diagnosis reduced the likelihood of having DKA at diagnosis by a respective 31% and 38%.
The author of a linked commentary, Astrid Guttmann (The Hospital for Sick Children, Toronto, Ontario, Canada), cautions that “[n]ot using primary care is not equivalent to having no access to care,” but highlights research showing that socioeconomic deprivation is linked to difficulties accessing healthcare, even within a universal, free at the point of use system.
Indeed, in the present study, being in the most deprived versus the least deprived tertile for socioeconomic status was associated with a significant 14% increased risk for having DKA at the time of diabetes diagnosis.
Guttmann therefore stresses that programs to improve primary healthcare access will need to include a focus on reducing inequality.
The population-based study included 3704 patients living in Quebec, Canada, who were younger than 18 years at the time of their type 1 diabetes diagnosis, between 2006 and 2015. Of these, 26.9% presented with DKA.
Children aged 5–11 years had a trend towards a reduced risk for DKA, by 16% and 11% for those who had seen primary care physicians and pediatricians, respectively, versus no primary care access, but this did not reach statistical significance.
Regular healthcare contact did not have a protective effect in children younger than 5 years, with the 17% of this group with no evidence of regular healthcare visits faring no worse than those who saw a family physician or pediatrician.
Meranda Nakhla (The Montreal Children’s Hospital, McGill University, Quebec) and co-researchers suggest that the lack of protective effect of regular healthcare could be because of unclear diabetes symptoms among these youngest patients or because they “may have less well-developed compensatory mechanisms, which could result in faster development of acidosis and dehydration.”
They write: “Increasing public or physician awareness of the symptoms of diabetes in this age group may mitigate the risk of DKA in younger children.”
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