Retrospective epidemiological study, with focus on acute and chronic managements, of patients attended the pediatric outpatient clinic of National Institute of Diabetes and Endocrinology, Cairo, Egypt

Diabetes mellitus is the most common endocrine metabolic disorder of childhood. It is widely spread all over Egypt as its prevalence was found to be 1.09 per 1000 among school aged children. The aim of this work was to do a retrospective epidemiological study of the records of diabetic children attended the outpatient pediatric clinic in NIDE. The files of 851 diabetic children were examined retrospectively without any reference to the personal data. Out of them, the files of 200 diabetic patients were also studied for determination of chronic management results represented by the type of insulin regimen used and estimation of the daily insulin dose per kg. We also assessed the outcome management of acute ketoacidosis from the files of 200 patients admitted to the ICU and npatient departments. All the resulted data had been subjected to SPSS statistical program. The results showed that there is no statistical differences between male, [n = 424] to female, [n = 427] distribution. The results of this retrospective study showed that the mean age of onset of diabetes in children attended the outpatient pediatric clinic of National Institute of Diabetes was [mean = 8.37 10.96 y]. The present study showed also that there was a decrease of age of onset of diabetes among diabetic children as the age of onset between 5- <10 years were the highest percentage [46%]. As regards the insulin regimen used by the diabetic children, 17.5% used conventional insulin therapy, 11% used modified insulin therapy as they used regular insulin before lunch, and 71.5% used basal-bolus insulin regimen. The mean percentage of insulin unites per Kg. was 1.00 + 0.38 U/kg./day. The mean BMI was = 24.54 + 6.42, while the BMI distribution was: 56% were with normal weight = < 25, 27% were overweight = 25: < 30, 14% were obese = 30: < 40 and only 3% were with severe obesity where BMI = > 40. The results showed also that 34.8% of the diabetic patients were doing continues home blood glucose monitoring with glucose sensors, 25.8% were doing the monitoring only with visual strips, while 39.4% of the diabetic children were not doing home monitoring at all. The study of control of diabetes showed that the glycated HbA Ic was < 7% in 31%, 7-8% in 22%, > 8-9% in 14% and > 9% in 33%. As regards the diabetic patients with ketoacidosis, 39% of them were diagnosed as the first presentation of diabetes. The duration required, for ketoacidosis, to be resolved was < 6 hr. in 44%, 6-12 hr. in 38.6%, > 12-24 hr. in 12.6%, and > 24% in only 3.8%. The results showed, also, that only 4.3% of DKA-cases were with PH < 7.0, 8.7% were with PH = 7: 7.1, 7.7% were with PH> 7.1: 7.2, 32.4% were with PH > 7.2: 7.3 and 7.2% only were with PH > 7.3. The above results showed also that 13.0% of ketotic cases were with severe acidosis, 7.7% were with moderate acidosis, and 32.4% were with mild acidosis. The discussion of these results documented that it will be essential to follow the international guidelines of management of type 1 diabetes and it was recommended to do proper diagnosis of different types ol diabetes among diabetic children and to study the prevalence anc incidence of diabetes among Egyptian children as the prevalent L and incidence still uncertain till now

Study of various epidemiological and metabolic criteria in diabetic children and adolescence attending pediatric outpatient clinic of NIDE

Type 1 diabetes mellitus is one of the greatest challenges in public health and one of the most frequent chronic diseases in the pediatric age. The aim of this study was to study the epidemiological and metabolic criteria of 398 diabetic children who attended the outpatient pediatric clinic with determination of beta cell function of theses patients. Study of the age of onset of diabetes, sex distribution, residency, with other epidemiological factors among diabetic patients, attended the outpatient clinic of NIDE during year 2008, who accepted to participate in this study. All patients were subjected to full history taking, thorough clinical examination and full laboratory investigations including: CBC, liver enzymes, s. creatinine, lipid profile, including total cholesterol LDL-cholesterol, HDL-cholesterol and triglycerides, fasting c-peptide, Glycated HbA1c, and estimation of microalbuminuria. There was positive correlations between: Age [mean = 10.34 +/- 12.7 y.] and BMI [mean = 27.79 +/- 8.66 kg/m2], systolic B.P. [105.23 + 6.86 mmHg.] and total cholesterol [mean = 175.74 +/- 38.09 mg/dl] and systolic B.P. and triglycerides [mean = 83.88 +/- 47.46 mg/dl], and a highly positive correlations as regarding age [mean = 10.34 +/- 12.7 y.] and glycated HbA1c [mean = 9.79 +/- 2.38%]. There were no significant difference between diabetic group with c-peptide < 1 ng/ml and group with preserved beta cell function with c-peptide> 1 ng/ml as regards: Glycated HbA1c, s. cholesterol, s. cholesterol LDL, microalbuminuria, BMI and age. While there was a positive statistical difference between both groups as regards s. triglycerides [mean=75.27+31.17mg/ dl and 102.27+49.6 mg/dl]. There was no significant difference as regarding sex distribution as the female percentage was 51% while male represented 49%. The family history of diabetes was positive in 6.7% as regards father, 5.2% as regards mother, 4% as regards siblings. The study of beta cell function was done through estimation of fasting c-peptide levels. 93.7% were with fasting c-peptide level < 1 ng/ml, while 6.3% were preserved beta cell function as fasting c-peptide levels were > 1 ng/ml. Only 34.8% of the patients were doing continues home blood glucose monitoring with glucose sensors, 25.8% were doing the monitoring only with visual strips, while 39.4% of the diabetic children did not doing any home blood glucose monitoring. The glycated HbA1c was <7% in 31%, 7-8% in 22%, > 8-9% in 14% and >9% in 33%. The study of BMI of the patients showed that 56% were not overweight, [BMI <25], 27% started to be overweight, [BMI 25-30], 14% were obese, [BMI 30-<40] while 3% only were with severe obesity [BMI >40]. According to the definition of metabolic syndrome criteria, the study of the metabolic criteria of the study group showed that 112, [28.1%] patients were with positive one metabolic criteria, 56 patients, [14%] with 2 positive metabolic criteria and 36 patients, [9%] with 3 positive metabolic criteria. So, in addition to the presence of hyperglycemia, 23% of the young diabetic patients fulfilled the criteria of metabolic syndrome

Serum homocysteine level in type 2 diabetic patients with diabetic nephropathy and its relation to albumin excretion rate

Objective: Hypercysteinemia has been established as an independent risk factor for coronary atherosclerotic disease which is the most common cause of mortality in patients with type 2 diabetes mellitus [Type 2 DM]. This study was undertaken to investigate the relationship of homocysteine [tHcy] and renal function as presented by creatinine clearance [CICD and albumin excretion rate [AER] as marker of nephropathy in type 2 DM

Patients and Methods: A total of 50 patients with type 2 DM were screened; 15 patients had normo-albuminuria, 23 patients had micro-albuminuria and the remainder 12 patients had macro-albuminuria. These diabetic groups were subdivided based on CrCl to those with normal CrCl [CrCl > 80 mL/min] and those with low CrCl [CrCl < 80 mL/min]

Results: There were no significant differences in tHcy levels between microand nonno-albuminuric patients [15.7+/-4 vs 14.6+/-3.3, p>0.05], there were significantly higher levels of tHcy in macro-albuminuric patients in comparison to normo-albuminuric patients [25.6+/-7.5 vs 14.6+/-3.3, p<0.001]. In all groups of patients, tHcy levels were higher in those with low CrCl than those with normal CrCl [16.8+/-1 vs 13.8+/-3.5, p<0.01; 19.9+/-2.2 vs 13.5+/-2.8, p<0.001; 28.03+/-6.1 vs 13.6+/-3.0, p<0.001 in normo-albuminuric, micro-albuminuric and macro-albuminuric patient groups, respectively]. In all patients with normal CrCl, tHcy levels were comparable irrespective of AER [micro-albuminuria vs normoalbuminuria 13.5+/-2.8 vs 13.8+/-3.5, p>0.05; macro-albuminuria vs normo-albuminuria 13.6+/-3.0 vs l3.8+/-3.5, p>0.05]. However, in patients with low CrCl, tHcy levels were higher in those with micro-albuminuria than normo-albuminuric patients [19.9+/-2.2 vs 16.8+/-1.0, p=0.01] and in those with macro-albuminuria in comparison to nonno-albuminuric patients [28.03+/-6.1 vs 16.8+/-1.0, p<0.001]

Conclusion: Using multivariate regression, CrCl is the strongest predictor of tHcy levels in patients With type 2 diabetes. These data strongly suggest that in patients with type 2 DM, the relationship between plasma tHcy and AER is attributed to changes in renal function as defined by CrC