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

ABSTRACT

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