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04-13-2018 | Healthcare systems | News

Regular healthcare access may reduce children’s DKA risk at diabetes diagnosis

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.”

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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