Characteristics at diagnosis of type 1 diabetes in children younger than 6 years
Received 26 April 2005; received in revised form 16 August 2005; accepted 11 October 2005.
Objective
To characterize the prodrome, presentation, family history, and biochemical status at diagnosis of type 1 diabetes mellitus (T1D) in children under age 6 years.
Study design
This was a retrospective chart review of patients hospitalized at diagnosis with T1D from 1990 to 1999 in a children’s hospital.
Results
A total of 247 children were hospitalized, 44% of whom presented in diabetic ketoacidosis (DKA). When stratified by 2-year age intervals, only total carbon dioxide (tCO2) was significantly lower in the youngest children (P = .02), and the duration of candidiasis was significantly longer in those children presenting in DKA (P = .004). Parents were more likely to recognize symptomatic hyperglycemia in children older than 2 years (P < .0001). Most parents sought care for their child suspecting that the child had diabetes; the other children were diagnosed when presenting with another concern. Only gender and tCO2 were significantly correlated with hemoglobin A1c (HbA1c); age-adjusted HbA1c was 0.64% higher in girls compared with boys (P = .045), and each 1-mmol/L decrement in tCO2 increased the age- and gender-adjusted HbA1c by 0.086% (P < .001).
Conclusions
A high proportion of children under age 6 years present critically ill at the diagnosis of T1D. When any of the classic symptoms of diabetes or a yeast infection is present, a serum glucose level should be measured.
From the Division of Endocrinology, Children’s Hospital Boston, Boston, Massachusetts, and Channing Laboratory, Harvard University, Cambridge, Massachusetts.
Reprint requests: Maryanne Quinn, MD, Division of Endocrinology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115.
ABSTRACT