{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:56:03Z","timestamp":1787928963485,"version":"build-2784847793"},"reference-count":36,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,11,20]]},"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the pathway to diagnosis of type 1 diabetes (T1D) in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Questionnaire completed by parents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Parents of children aged 1\u2005month to 16\u2005years diagnosed with T1D within the previous 3\u2005months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Children and parents from 11 hospitals within the East of England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>88\/164 (54%) invited families returned the questionnaire. Children had mean\u00b1SD age of 9.41\u00b14.5\u2005years. 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\u2005days (median 25\u2005days). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-006470","type":"journal-article","created":{"date-parts":[[2015,3,17]],"date-time":"2015-03-17T22:33:31Z","timestamp":1426631611000},"page":"e006470","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["The pathway to diagnosis of type 1 diabetes in children: a questionnaire study"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8501-2531","authenticated-orcid":false,"given":"Juliet A","family":"Usher-Smith","sequence":"first","affiliation":[{"name":"The Primary Care Unit, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Zhu","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Sharp","sequence":"additional","affiliation":[{"name":"MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[{"name":"The Primary Care Unit, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,3,17]]},"reference":[{"key":"2025121219483018000_5.3.e006470.1","doi-asserted-by":"publisher","DOI":"10.2337\/db13-1891"},{"key":"2025121219483018000_5.3.e006470.2","doi-asserted-by":"crossref","unstructured":"Fazeli Farsani S , Souverein PC , van der Vorst MMJ , et al . 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