The Clinical Characteristics And Follow-up Analysis Of Newly Diagnosed Type 1 Diabetes In Children

Part ? Analysis of the clinical characteristics of children with newly diagnosed type 1 diabetes[Objective] To analyze the clinical characteristics of children with newly diagnosed type 1 diabetes mellitus(T1DM)in a single center,and to provide the basis and new direction to clinical diagnosis and scientific research.[Methods] The clinical data obtained from 482 children with newly diagnosed T1 DM admitted to our hospital from January 2010 to December 2017 were analyzed retrospectively.It was further analyzed and summarized based on the clinical features,differences between age groups,presence of diabetic ketoacidosis(DKA)during onset,euthyroid sick syndrome(ESS)and vitamin D deficiency.Children who visited the child health care clinic for health examination with 25-hydroxyvitamin D(25-(OH)D)test and without acute or chronic diseases were selected as normal control group and compared with T1 DM children.[Results](1)Cases of newly diagnosed children with T1 DM is increasing year by year.The average annual growth rate in the last 8 years is 13.3%.Fasting C peptide(FC-P)increased after achieving therapy,and the degree of increase was negatively correlated with the time of correcting DK/DKA.The average time to correct DK/DKA was 2.8 days.Nearly half of the children entered the honeymoon period before discharge and the average time consumed was 13 days.(2)The proportion of female patients,onset time,Hb A1 c,FC-P,and 2 hours postprandial C peptide(2h C-P)value increased with age.On the other hand,the proportion of cesarean section birth,25-hydroxyvitamin D,fasting blood glucose(FBG),and 2 hours postprandial blood glucose(2h BG)decreased with age.The proportion of DKA or ESS were found to be the highest at children under 3 years old.In the ?12 and <3 years old age groups,it was found that the proportion of severe DKA was high,the dosage of insulin use was large,and the proportion of entering the honeymoon period was low.Children between 3-6 year old had the lowest insulin dosage and highest honeymoon period.(3)ESS is positively related to the severity of DKA.Compared with control group,patients with DKA or ESS had lower serum sodium level,FC-P and 2h C-P,higher triacylglycerol,FBG and 2h BG,longer time to correct DK/DKA;they also require more insulin dosage,lower proportion of entering honeymoon period and more time-consuming.(4)The level of 25-(OH)D in children with T1 DM was significantly lower than that in normal children,and the proportion of vitamin D deficiency increased significantly.The patients within the vitamin D deficiency group had higher 2h BG,more dosage of insulin,lower proportion of entering honeymoon period and more time-consuming as compared to the sufficient group.[Conclusions](1)The incidence of T1 DM in children is increasing quickly and the situation is grim.(2)Age of onset maybe related to the childbirth method of the patient and their gender.(3)The clinical characteristics of children in different age groups are different.Therefore,individualized diagnosis and treatment strategies should be formulated in the clinical practice.(4)DKA,ESS and vitamin D deficiency are closely related to the severity and recovery of the disease.Early monitoring and diagnosis,as well as reasonable treatment to protect and manage the residual islet ?-cell function are vital.Part ? Analysis of follow-up cases of type 1 diabetes in children:a single center study[Objective] The study is a retrospective follow-up data of children with type 1 diabetes mellitus(T1DM)in a single center,used to explore the condition and related factors of glycemic control and its complications;to provide evidence between glycemic control and early monitoring with prevention of complications.[Methods] The follow-up data were obtained from children with newly diagnosed T1 DM who were admitted to our hospital from January 2010 to December 2017.Data of nerve conduction studies(NCS)and electrogastrogram(EGG)examination were obtained from children with a clinical course more than 1 year.Patients were divided into groups according to the Hb A1 c,age,results of NCS or electrogastrogram examination.Analysis of the condition and related factors of glycemic control and complications were done using t test,analysis of variance,general linear model and multiple Logistic regression analysis.[Results] In our hospital,the rate of glycemic control reaching standard in children with T1 DM was 32.4%.The study shows that the children whose blood glucose control did not reach the standard had longer course of disease,lower usage of insulin pump and higher proportion of severe diabetes ketoacidosis(DKA)at onset.In this study,the prevalence of diabetic peripheral neuropathy(DPN)is 53.9% and the average duration of onset is 30.4 months.The incidence of abnormal gastric electrical rhythm is 63.2%,with the average duration of onset is 35.2 months.The F wave of tibial motor nerve was prolonged in 88.5% of patients with DPN,and the pre-prandial gastric electric rhythm was abnormal in 70.9% of patients with abnormal gastric electric rhythm.Patients with DPN were older in age and had a longer course of disease,higher Hb A1 c and triglyceride level(TG).The group of aggravated DPN had higher standard deviation of blood glucose level(SDBG),maximal blood sugar fluctuation range(LAGE),Hb A1 c and total cholesterol(TC)compared with alleviated group.Furthermore,SDBG was an independent risk factor for DPN aggravation.Abnormal gastric electric rhythm was associated with long course of disease and low fasting C peptide.[Conclusions] In this research of a single center,the control of blood glucose in children with T1 DM is poor.Thus,glycemic control rate is low.The insulin pump therapy can help to decrease the average blood sugar and reduce the fluctuation of blood sugar.The incidence of DPN,abnormal gastric electric rhythm in children with T1 DM is high and develop during the early onset.Thus,early monitoring and prevention are necessary.