Varying clinical presentations at onset of type 1 diabetes mellitus in children - epidemiological evidence for different subtypes of the disease?

Abstract

Although the symptoms of diabetes at its onset follow a uniform pattern, the clinical presentation and duration of symptoms indicate that there may be various forms of type 1 diabetes.

Characteristics at diagnosis of type 1 diabetes in children younger than 6 years

“…4,6-8, [12][13][14]23 Although others have reported that a positive family history of T1D is associated with the earlier recognition of symptoms of newonset diabetes, 7 we did not find a correlation between a history of T1D in a first-degree family member and early recognition of symptomatic hyperglycemia in children under age 6 years.…”

“…One possible explanation for this difference is that we have studied an age-restricted group, whereas other investigators have compared children under age 5 years to children 5 years and older. 9,11,14 An alternative explanation is that younger children do not have a shorter period of inadequate insulin secretion but do have a more severe metabolic decompensation at diagnosis. Our data support this explanation because we found no correlation between age and HbA1c across a 6-year age span, although we identified an age-related inverse correlation with tCO 2 at diagnosis.…”

“…[7][8][9][10][11][12][13] The concomitant occurrence of an infectious illness has often been noted in young children at diagnosis, and the acute illness may precipitate metabolic decompensation in the child with limited ␤-cell reserve. [14][15][16] Early identification is essential to reduce the morbidity and mortality associated with new-onset diabetes in this vulnerable age group. [7][8][9][10][11][12][13] The purpose of this study was to characterize the prodrome, presentation, family history, and biochemical characteristics at the time of diagnosis of T1D in children under age 6 years and to increase the awareness of the signs and symptoms of new-onset diabetes in preschool-age children among primary care clinicians (PCCs).…”

Diabetic ketoacidosis in children: an 11-year retrospective in Surabaya, Indonesia

“…[5][6][7][8][9] It remains unknown why some children present in DKA and whether the development of diabetic ketoacidosis is a consequence of delayed diagnosis and treatment or whether it reflects a particularly aggressive form of diabetes. 10 In our study, 39.7% and 37.9% of patients suffered from moderate and severe DKA, respectively. Other studies reported that mild DKA was more frequent than moderate and severe.…”

Prevalence and Incidence of Endocrine Disorders in Children: Results of a Survey in Baden-Wuerttemberg and Bavaria (EndoPrIn BB) 2000–2001

“…In Germany till now no studies exist about the frequency of these diseases. Studies about the frequency of diseases, like the one about diabetes mellitus type 1 [8,25,26] are of considerable interest for the health-care system. They establish the conditions to plan the logistics of paediatric endocrinology and diabetology in Germany.…”