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Master Thesis

Facteurs favorisant l’acidocétose diabétique inaugurale lors du diagnostic de diabète de type 1 chez l’enfant : étude rétrospective et évaluation des pratiques des médecins généralistes de l’agglomération caennaise

Abstract : Aims: to evaluate factors related to inaugural diabetic ketoacidosis (DKA) in type 1 diabetes (T1D) diagnosed in children. Material and Methods: a retrospective observational study compared patients under 16 reporting T1D between 2009 and 2018 at the University Hospital of Caen depending on the severity of DKA. Age, parents' profession, family history of T1D, inadequate corticosteroid therapy, diagnostic and clinic-biological parameters were studied. A questionnaire assessing barriers to the child's diagnosis of T1D was sent to general practitioners (GP) of “Caen La Mer” in August 2018. Results: the study included 132 children. The prevalence of DKA was 40,2% with 15,2% for severe forms. The DKA, severe or not, was associated with the absence of parents' profession (<0,05), the diagnosis to pediatric emergencies (PE) (p<0,0001) and the existence of a consultation before diagnosis to PE (p<0,05). Corticosteroids was associated with severe DKA (OR = 4,42; p = 0,023) unrelated to the frequency of the DKA. An intermediate profession (p<0,05) and blood sample in the laboratory (p<0,0001) were inversely related to the DKA. The questionnaire was completed by 26,8% of GP. A large part differs diagnosed T1D by achieving prior blood sampling in laboratory, inexperience and confusion with type 2 diabetes. One difficulty is noted for nearly 3 quarters of GP, mainly for lack of equipment and experience. Conclusion: inadequate corticosteroid therapy and diagnostic delay are the main factors related to DKA and its severity, probably impacted by the lack of GP experience.
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Master Thesis
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Submitted on : Monday, September 30, 2019 - 11:56:45 AM
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Thomas Chombart. Facteurs favorisant l’acidocétose diabétique inaugurale lors du diagnostic de diabète de type 1 chez l’enfant : étude rétrospective et évaluation des pratiques des médecins généralistes de l’agglomération caennaise. Médecine humaine et pathologie. 2019. ⟨dumas-02301203⟩

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