الفهرس 
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Abstract
SUMMERY
his study to assessment of physician awareness to the
presentation of type 1 diabetes mellitus (T1DM) in
children and adolescents, to assess the possible misdiagnosis of
presentation of T1DM in children and adolescents, to assess the
time for children and adolescents needed from presentation till
a diagnosis of T1DM and to asses impact of time needed for
diagnosis and presentation with diabetic ketoacidosis (DKA).
A structured questionnaires were used, they were directed
to 60 doctors dealing with children and adolescents (general
practitioner, pediatric resident and pediatrician) and 200 diabetic
patients following up at the diabetes clinic or their parents.
The doctors questionnaire test their knowledge of all
inclusion of screening for T1DM in conditions that are possible
differential diagnosis, presenting symptoms of T1DM, prevalence
and trend of T1DM in Egypt and by generally test their
knowledge about T1DM.
The patient questionnaire including the presentation history
(emergency and non emergency), family history, number of
physicians examining the patient before the diagnosis was made,
time and duration between the development of the first symptoms
and getting the final diagnosis, development of acute
complications in the form of DKA and percent of patients
diagnosed with DKA, duration of hospital admission at diagnosis
in relation to the various presentations and the time to diagnosis
and test their knowledge about T1DM.
T
Summary
72
After statistical analysis of the collecting data from all
questionnaires and studying of the results we found the
following about doctors:
• More included doctors were pediatricians (46.7%).
• Most of included doctors (46.6%) have 2-3 years duration of
practice and mean of 5.93±5.78 years.
• Most of included doctors(81.67%) included DM in
differential diagnosis if the child presents with vomiting,
100% if the child presents with polyuria, 65% if the child
presents with SOB, 73.33% if child presents with abdominal
pain and 76.67% of doctors exclude DM if child presents
with nocturnal enuresis.
• Most of included doctors (88.3%) knows that the prevalence
of T1DM in Egypt is rising.
• Most of included doctors (80%) considered that DKA is
always the presentation of T1DM in children.
• Most doctors give correct answers regarding T1DM
presentation and family history but 43.3% of them consider
that it is best treated with premixed insulins.
• About half of doctors (48.3%) have seen patients that
diagnosed as diabetes but were proved later to haveT1DM.
• Neither the specialty or duration of practice were significant
in affecting doctor awareness of T1DM.
Summary
73
And found the following about patients:
• The mean patients’ age was 11.34 ± 4.36 years, patient sex
(60% female&40% male), and mean duration of DM was
4.45 ± 3.54 years.
• Fifty six percent (56%) of patients have family history of
diabetes.
• About half (49.5%) of all studied patients were older than 12
years of age.
• Almost half of patients (48.5%) were diagnosed between >6-12 years old.
• Most of our patients had duration of DM of 2-6 years
followed by those <2 years then those with a duration of >6-12 years.
• Most common symptoms at DM presentation was weight
loss.
• Ninety seven and half percent (97.5%) of patients had
hospital admission and 18.5% only were admitted in
intensive care unit (ICU).
• Most of admitted cases (56.92%) presented with diabetic
ketoacidosis (DKA).
• Mean duration of hospital admission was about 15.18days
per patient, increased with patients aged (< 2 years) at
diagnosis and decreased in (>6-12 years) category.
Summary
74
• The mean duration between presentation and diagnosis was
21.32±10.75 days, increased with patients aged (>12years)
at diagnosis and decreased in (2-6 years) category.
• There is no significance for family history in length of
duration between presentation and diagnosis of DM.
• One hundred and forty (140) cases (70%) needed 1 doctor to
be diagnosed and 60 cases(30%) needed more than 1
doctor(a mean of 1.50±0.33 doctor).
• Fifty six percent (56%) of patients were seen by
pediatricians and most of those who misdiagnosed them at
first presentation were 50% pediatricians and 26% were
internists.
• Most patients (40%) who needed more than one doctor were
aged >6 -12 years at diagnosis and 60% of patientsaged <2
years at diagnosis were misdiagnosed.
• Twenty seven (27%) of misdiagnosed cases were diagnosed
as gastroenteritis.
• Sixty four and half (64.5%) of patients experienced DKA
attacks (at presentation and after that) and increased in
patients aged > 12 years.
• Most of patients experienced in DKA attacks > 2 - 6years
duration of DM.
• Ninety seven and half percent (97.5%) of patients know that
cases of DM in children in Egypt is increasing.
Summary
75
• Most of patients think that the cause of DM is either
hereditary or 2ry to infection.
• Most of patients consider that the associated complication to
T1DM mainly on eye, kidney, heart and 83.50% consider
diabetic foot as one of the main complications
• Ninety two percent (92%) of patients see that good control
may prevent the Complications of DM.