Profile of Diabetes Mellitus at presentation in children under 12 years of age

Abstract

Incidence of diabetes in children is on the rise due to both Type 1 and Type2 Diabetes Mellitus(DM). This retrospective study was conducted among 432 children diagnosed to have DM at less than 12 years of age. The profile of diabetes at presentation was studied in all these children. Type 1 DM was encountered in 81% of children. Two children were Type 2 DM. Age and gender did not show any statistical difference. BMI was less than 85 th percentile in all but two children. 58.6% of children presented with Diabetic keto acidosis. 93 % of the children presented with osmotic symptoms. Incidental diagnosis of DM was encountered in 45%. Missed diagnosis was encountered in 60% of children with DKA. 12.5 % were found to have autoimmune thyroid antibodies. Hypercholesterolemia was encountered in 16% and hyperlipidemia in 19%. Mortality at initial diagnosis was 2.7%. Type 1 DM is the commonest type encountered in children under 12 years of age from a lower socioeconomic strata and nearly 60% present with DKA at onset. 60% children with DKA have their diagnosis missed at first physician contact.

Keywords

• Diabetes Mellitus, Children under 12 years, onset, clinical features

References

1. Ronald CW, and Juliana CN . Nature reviews endocrinology 2009;5:529– 530. DM in children is on the rise perhaps due to rise in type 2 diabetes and possibly type 1 diabetes.
2. EURODIAB ACE study group. Variation and trends in incidence of childhood diabetes in Europe. Lancet 2000:355: 873-876.
3. C.Prapai D, Ram K,Mark A.Sperling. Childhood Diabetes mellitus recent advances and future prospects. Indian J Med Res. 2001;125: 231- 250.
4. Kalra S, Kalra B, Sharma A. Prevalence of Type 1 diabetes mellitus in Karnal district, Haryana state, India. Diabetol and metab syndr 2010; 2:14 -17
5. Ramachandran A, Snehalatha C, Krishnaswamy CV. The Incidence of IDDM in children in urban population in southern India. Madras South India. Diabetes Res Clin Pract.1996;34:79–82.
6. Ishwar C.Varma .The challenge of childhood diabetes mellitus in India. Indian J of Pediatr.. 1989;56: S33-S38.
7. Al-Fifi SH. The relation of age to the severity of Type I diabetes in children. J Fam Community Med 2010;17:87-90
8. Oski's essential pediatrics. Edr. Michael Crocetti, Michael A. Barone, Frank A. Oski . Lippincott Williams & Wilkins, 2004 2nd edition. chapter 208. Type 1 Diabetes mellitus. pages 593-594

9. Jyotsana VP, Singh SK, Gopal D, Unnikrishnan AG, Agrawal NK, Singh SK, et al. Clinical and biochemical profiles of young diabetics in North- Eastern India. J Assoc Physicians India. 2002;50:1130-1134. 10. Menon PS, Vaidyanathan B, Kaur M. Autoimmune thyroid disease in Indian children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2001 ;14:279-286.
10. Rahim V, Mahmood M, Ali G. Prevalence of thyroid antibodies in diabetic children and asolescents in Mashhad. Iranian Journal of Diabetes and Lipid Disorders.2004;3:52-54
11. Krishna P, Roopakala, Prasanna Kumar KM. Dyslipidemia in type 1 diabetes mellitus in the young. Int J Diab Dev Ctries 2005;25:110-112
12. Sundaram PC, Day E, Kirk J. Delayed diagnosis in type I diabetes mellitus. Arch Dis Child 2009;94:151-152.
13. Helen B, Teresa T, Robert S, Kinwah F, Denis D.Is Diabetic Ketoacidosis at Disease Onset a Result of Missed Diagnosis? The Journal of Pediatrics. 2010; 156:, 472-477.
14. Maryanne Q, Amy F, Bernard R, Daniel J. Nigrin,
15. J and Wolfsdorf Characteristics at diagnosis of type 1 diabetes in children younger than 6 years.Journal of Pediatrics. 2006; 148: 366-371