| Objective 1)To explore the clinical characteristics of children and adolescents with newly diagnosed type 1 diabetes mellitus hospitalized and the related influence factors of Diabetic Ketoacidosis(DKA),then study the risk factors of DKA. 2)To discuss the change of the clinical features of type 1 diabetes mellitus diagnosed at different time. 3)To investigate the subsequent treatments of newly diagnosed diabetes mellitus.Methods 1) In the retrospective clinical characteristics study,138 children or adolescents newly diagnosed with type 1 diabetes mellitus from January 1st 2000 to December 31 th 2015,in Tongji Hospital Affiliated of Huazhong University Science and Technology were selected. They were divided into DKA group and non-DKA group according to the standard. Then compared the differences between them. 2) Patients diagnosed in 2000~2007 and those in 2008~2015 were compared the differences between them 3) Patients among the above coming back hospital once again were selected and analysed their characteristics.Results 1)Among the 138 cases newly diagnosed diabetes mellitus,58 children(42%) had DKA, and the rest(58%) did not have DKA. In the group of DKA and non-DKA,the rate of male is 50% and 52.5%,respectively. In the group of DKA,29 cases(50%) were registered in rural,while in the non-DKA group 43 cases(53.8%) were registered in rural.7 cases(12.1%) had family history of diabetes in the DKA group, and 14 cases(17.5%)had family history of diabetes in the non-DKA group. In the DKA group, the average age of onset was(7.45±3.68)years old. In The non-DKA group, the average age of onset was(6.91±3.71)years old.48 cases(82.8%)had polydipsia in the DKA group, and 73cases(91.3%) in the non-DKA group. 36 cases(62.1%)had loss of weight in the DKA group, while in the non-DKA group,it was 52 cases(65.0%). In the DKA group, the average Hb A1 c was(12.80±2.42)%.In the non-DKA group, it was(11.98±2.47)%.The average TT3 was(1.07±0.75)mmol/L in the DKA group, and in the non-DKA group it was(1.31±0.50)mmol/L. In the DKA group,5 cases(15.2%)had ICA positive, and 6 cases(12.0%) in the non-DKA.7 cases(21.2%)had GADA positive in the DKA group, while in the non-DKA group,there were 3 cases(6.0%). There weren't significant differences in the above factors(P>0.05). In the DKA group,the duration of symptoms was 10.0(4.75,22.5)days,and in the non-DKA group, the duration of symptoms was 16.0(10.0.30.0)days.32 cases(55.2%)had infection history in the DKA group, while 30 cases(37.5%)had infection history in the non-DKA group. In the DKA group,10 cases(17.2%) had good appetite, and 40 cases(50%) in the non-DKA group.17 cases(29.3%)had vomiting in the DKA group,while in the non-DKA group 4 cases(5.0%). In the DKA group,12 cases(20.7%)had stomachache, and in the non-DKA group,6 cases(7.5%).15 cases(25.9%)had weakness in the DKA group, while in the non-DKA group,4 cases(5.0%)had weakness. In the DKA group, the average blood sugar was(29.73±10.79)mmol/L, and in the non-DKA group, it was(18.47±8.69)mmol/L. The average cholesterol was(5.14±1.34)mmol/L in the DKA group, while in the non-DKA group it was(4.20±1.05)mmol/L. In the DKA group, the blood lipids was 3.67(1.46,6.10)mmol/L, while in the non-DKA group, it was 1.47(0.97,2.19)mmol/L. The average TT4 was(78.38±46.47)mmol/L in the DKA group, and, it was(99.08±30.09)mmol/L in the non-DKA group. In the DKA group, the fasting c-peptide was(0.38±0.27)ug/L, while it was(0.55±0.42)ug/L in the non-DKA group.The average insulin dosage was(0.91±0.40)IU/kg in the DKA group. In the non-DKA group,it was(0.75±0.34)IU/kg. The days in hospital in the DKA group were(15.42±5.54)days, and(13.01±5.41)days in the non-DKA group. In the DKA group, the average cost was 12393.6(8465.6,31535.9)yuan,while it was 8821.3(6231.6,11489.8)yuan in the non-DKAgroup. The above factors in the two groups had significant differences(P<0.05).We got the gender(male),family history of diabetes, age of onset, duration of symptoms, polydipsia, good appetite, glycemic rating, fasting c-peptide and Hb A1 c logistic regression analysed. The OR of glycemic rating was 3.496(95%CI 1.665~7.341),the OR of good appetite was 0.297(95%CI 0.089~0.989),the OR of gender(male) was 1.073(95%CI 0.381~3.020),the OR of family history of diabetes was 0.573(95%CI 0.130~2.537),the OR of age of onset was 1.198(95%CI 0.990~1.450),the OR of duration of symptoms was 0.995(95%CI 0.984~1.007),the OR of polydipsia was OR=0.347(0.046~2.610),the OR of fasting c-peptide was 0.152(95%CI 0.019~1.212),the OR of Hb A1 c was 1.016(95%CI 0.799~1.406). 2)Children diagnosed in 2000~2007 had 32(23.2%),and in 2008~2015 had 106(76.8%).14 cases(43.8%)were male in 2000~2007,and 57 cases(53.8%) in 2008~2015.13 cases(40.6%)were registered in rural in 2000~2007,while in 2008~2015,59 cases(55.7%)were registered in rural. 7 cases(21.9%)were below 5 years old in 2000~2007,while in 2008~2015,there were 37 cases(34.9%). In 2000~2007,12 cases(37.5%)had DKA, and 46 cases(43.4%)had DKA in 2008~2015. The above factors in the two groups did not have significant differences(P>0.05).No one used the insulin pump in 2000~2007,while 63 cases(59.4%)used the insulin pump in 2008~2015.The age of onset was(8.51±3.45)years old in 2000~2007.The age of onset was(6.72±3.69)years old in 2008~2015. There were significant differences in the above two factors of the two groups(P<0.05). 3)Among the 138 cases,37 cases came back hospital once again, and the treatment interval between the first time and the second time was(1.61±1.42)(0.08~7.00)(years). There were significant differences in the following factors for patients between the secondary treatment and the first treatment: the rate of polydipsia(8.1% vs 86.5%),the rate of polyuria(5.4% vs 91.9%),the rate of good appetite(5.4% vs 37.8%),the rate of DKA(18.9% vs 40.5%),the blood sugar(12.98±8.77 vs 23.78±10.76)mmol/L,Hb A1 c level(9.44±3.05 vs 12.63±2.59)%,the fasting c-peptide(0.22±0.25 vs 0.54±0.41)ug/L, the blood lipids level(1.03(0.67,1.31)vs 1.74(1.00,2.34))mmol/L, the cholesterol level(3.70±0.77 vs 4.22±1.09)mmol/L.There were not significant differences between them(P>0.05).Conclusions 1?1) Higher blood sugar is an independent risk factor for DKA, but better appetite is a protective factor. 2) When DKA occurs, for Children with newly diagnosed type 1 diabetes mellitus, the blood lipids level and cholesterol level is higher, while the fasting c-peptide is lower. 3) Many children with type 1 diabetes mellitus have hypothyroidism, and it is worse when DKA occurs. 4) When DKA occurs, for Children with newly diagnosed type 1 diabetes mellitus, the average insulin dosage is bigger, days in hospital are longer, and the cost is higher. 2?In recent years, the age of children with type 1 diabetes mellitus is younger, and more patients choose the insulin pump. 3?After treated for some time, Children with newly diagnosed type 1 diabetes mellitus will rarely show clinical symptoms, and the blood lipids and cholesterol level will also improve. |
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