P-77: Overcoming diagnostic inertia in pediatric type 1 diabetes: a mixed-methods evaluation of primary healthcare competencies in rural India
V Sharma, S Sharma, U Gangadhar, C Kumar, S KumariAbstract
Introduction
In rural health ecosystems, specialized pediatric endocrinologists are scarce, shifting the burden of recognizing early pediatric type 1 diabetes (T1D) onto general primary care providers. Defining the specific educational deficits faced by these frontline practitioners is critical for deploying early-detection frameworks and preventing life-threatening diabetic ketoacidosis (DKA) at onset.
Objectives
To quantify clinical proficiencies and characterize systemic barriers related to the early identification and management of pediatric T1D among primary care practitioners (PCPs) in a resource-constrained rural healthcare network.
Methods
A cross-sectional, mixed-methods evaluation involved 678 primary healthcare professionals. Quantitative proficiencies regarding classic T1D presentation (polyuria, polydipsia, weight loss), DKA recognition, and initial management were captured via a structured scoring instrument. Concurrently, thematic analysis of qualitative responses mapped institutional barriers to point-of-care glucose screening.
Results
The cohort exhibited profound clinical blind spots, with only 36.4% demonstrating adequate diagnostic literacy. Notably, 27% of practitioners erroneously attributed early T1D or DKA symptoms to acute gastroenteritis or respiratory infections, driving referral hesitancy and treatment latency. Medical officers scored significantly higher across clinical domains compared to nursing personnel (P=0.01). Thematic data revealed that acute resource limitations, such as lack of functioning glucometers and absent clinical pathways, severely paralyzed screening implementation.
Conclusions
Frontline rural practitioners harbor significant diagnostic misconceptions regarding pediatric T1D, frequently masking true pathology as common pediatric infections. Embedding low-barrier point-of-care glucose screening algorithms into routine rural pediatric care is critical to accelerating accurate diagnoses and preventing DKA.