The changing presentation of children with newly diagnosed type 1 diabetes mellitus

Abstract

Although it is known that the incidence of type 1 diabetes mellitus (DM) in childhood is progressively increasing, it is less clear whether the presentation of newly diagnosed DM is changing. The aim of this study was to establish whether any biochemical or clinical presentation parameters have altered over time. A retrospective study was performed comparing newly diagnosed children with DM in two 24 month time intervals, 8 yrs apart (1988-89 and 1995-96). Fifty-seven children were diagnosed with type 1 DM in 1988-89 and 70 children in 1995-96. At presentation, children born in the later cohort had a higher pH (p < 0.001) and lower serum glucose (p < 0.05). Although the frequency of diabetic ketoacidosis (DKA) was higher in the 1988/89 cohort (63% vs. 42% in 1995/96) the absolute number of children with DKA in each time interval was similar (33 subjects in 1988-89 vs. 30 subjects in 1995/96). Islet cell antibody (ICA) levels were very different between the two cohorts; higher antibody levels were found in the 1988/89 group (p < 0.01). DKA was also associated with higher ICA titres (p < 0.05). Hospital admission stay decreased from 6.5 DS to 3.4 DS over the 8-year period (p < 0.0001). At our institution, the presentation of children with type 1 DM is changing with many more children diagnosed before developing DKA. We speculate that a new environmental factor(s) may be responsible for the absolute increase in patients presenting without DKA, while older etiologies (both genetic and environmental) are responsible for the steady, unchanging number of patients with a more severe presentation. Greater awareness of diabetes in children is not the factor contributing to earlier diagnosis before DKA develops.

Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in Northern Finland

“…1B and C). Similar time trends have been observed in other studies (8,21), although there also has been a report of increasing DKA frequencies in children with newly diagnosed type 1 diabetes (10).…”

“…The overall frequency of DKA in our study was lower [DKA(i) 18.1%, DKA(ii) 22.4%] than the corresponding frequencies in many earlier studies (10,21). For example, in the report of the EURODIAB project covering 24 centers in Europe, the overall proportion of DKA (pH Ͻ7.30) was 40% in 11 centers that recorded DKA, varying from 26 to 67% (5).…”

Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis

“…Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes and is present in 15-67% of children at the time of diagnosis [1][2][3][4][5][6][7]. The prevalence of onset DKA varies widely among studies, but most studies have been hospital-based and might therefore have been influenced by the selection bias of hospital referral [2,4,6].…”

“…The prevalence of onset DKA varies widely among studies, but most studies have been hospital-based and might therefore have been influenced by the selection bias of hospital referral [2,4,6]. There is substantial variation in the incidence rate of type 1 diabetes in children below 15 years in Europe and the regional incidence rate of type 1 diabetes has been reported to be inversely correlated with the prevalence of DKA at diagnosis [1,8].…”

Testing the Accelerator Hypothesis: Body Size, β-Cell Function, and Age at Onset of Type 1 (Autoimmune) Diabetes

“…Two other U.K. studies of almost exclusively white children (5,6) and a large European study involving many thousands of predominantly white children (7) have all shown the predicted inverse relationship between age at onset and BMI on simple univariate regression. Furthermore, a German study involving 920 children with type 1 diabetes shows the same (8), and a study of pre-type 1 diabetic children from Australia suggests that the more insulin resistant the child, the more rapidly he/she progresses to type 1 diabetes (9). Longitudinal studies will be important to further elucidate the accelerator hypothesis, as Dabelea et al suggest, but the real test will be a randomized controlled trial to reduce insulin resistance in at-risk children of type 1 diabetes.…”