ABSTRACT
The incidence of type 1 diabetes mellitus is increasing worldwide especially in toddlers and preschool children in whom the disease appears to run a more accelerated course than the elder age group. To determine the epidemiological and clinico-pathological features of type 1 diabetes in Egyptian toddlers and preschool children. 120 diabetic patients were included divided into two groups: according to age at presentation: group I [N = 60], aged < 5 years at presentation [32 males and 28 females] diagnosed in the period from January 1[st] 2006 till December 31[st] 2006; group II [N = 60], aged > 5 years at presentation [30 males and 30 females]. They were diagnosed in the period from January 1[st] 2000 to December 31[st] 2005. Patients were subjected to thorough history, and examination. Laboratory investigations included; random blood sugar [RBS], glycated hemoglobin [HbA[1c]] every 3 months as well as C-peptide assessed initially and after 6 months. Structured questionnaire was filled by parents for assessment of diabetic risk factors. There was a steady increase in the percentage of diabetic toddlers and preschool children in relation to total number of diabetic patients diagnosed in the 6 years period, increasing from 16% in the year 2000 to 23.3% in year 2005. The median duration of exclusive breast feeding was 2 months in patients with early onset versus 4 months in patients with late onset of diabetes. The median duration of total breast feeding was 9.5 months versus 11.2 months in patients with early onset diabetes mellitus and late onset respectively. Median age of introduction of cow milk was 2.5 months in early onset diabetics [range 1-5.3] compared to 4 months in late onset diabetics [range 2-7]. History of preceding clinical infection [febrile illnesses] occurred in 73.3% and 33.3% in diabetic toddlers and older age group respectively [p<0.0001]. 50% of young diabetics were diagnosed in winter and autumn versus 25% of older group [< 0.05]. More aggressive disease presentation in the toddler group as 75% had diabetic ketoacidosis [DKA] as a presenting symptom compared to 38.3% of the older diabetics [p<0.0001]. Higher initial RBS, higher incidence of hypoglycemia attacks in diabetic toddlers compared to older age group [p<0.0001]. Higher mean insulin dose and mean random blood sugar follow up values were found in young diabetics [p<0.01]. Young diabetics had significantly lower initial C-peptide values [p<0.0001] as well as significantly lower 6 months follow up values [p<0.0001] compared to older age. Initial C-peptide values were negatively correlated with initial RBS [r = -0.335; p<0.05] and mean insulin dose [r = -0.609; p<0.0001] while it positively correlated with age at presentation [r = 0.538; p < 0.0001]. The role of environmental factors in triggering type 1 DM was highlighted especially in toddlers with more aggressive presentation and disease course which was related to lower beta-cell reserve