Epidemiological and clinical features of newly diagnosed diabetes cases in hospitalized children in a single center from 2010 to 2016 / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the epidemiological features,clinical classification,clinical manifestation and the detection of islet autoantibody of the children with diabetes hospitalized in a single center.Methods A retrospective analysis was performed on the 431 patients with diabetes newly diagnosed at the Department of Endocrinology,Capital Institute of Pediatrics-Peking University Teaching Hospital from January 2010 to December 2016.The medical records,including the number of children per year,the proportion of various types of diabetes,children's general situation,family history,blood sugar,urine and urine ketone body,blood gas analysis,fasting C peptide,and islet autoantibody test results,were analyzed.Results Of the 431 patients,there were 309 cases (71.7％) of type 1 diabetes mellitus (T1DM),86 cases (20.0％) of type 2 diabetes mellitus (T2DM),22 cases (5.1％) of special type of diabetes and 14 cases (3.2％) of undetermined type of diabetes.Maturity onset diabetes in young (MODY) was found in 16 cases out of 22 special type of diabetes.Nine MODY children underwent gene detection,and 2 children were detected with mutation in the GCK gene(c.370G ＞ C,p.D124H;c.707A ＞ G,p.E236G) and the types were MODY2.The annual number of children with diabetes from 2010 to 2016 were 43 cases,50 cases,65 cases,65 cases,68 cases,75 cases and 65 cases respectively,and the growth rate increased 51.2％ from 2010 to 2016.The median age of T1 DM patients at diagnosis was 7.0 years old,compared with 12.7 years of T2DM patients;94.5％ (292 cases) of T1DM patients had typical " three polys and one little" symptoms of diabetes,compared with 75.6％ (65 cases) of T2DM patients;41.1％ (128 cases) of T1DM patients had ketoacidosis at the onset of diabetes,compared with 16.2％ (14 cases) of T2DM patients;33.0％ (102 cases) of T1DM patients had family history of diabetes,compared with 74.4％ (64 cases)of T2DM patients;the median of fasting C peptide of 302 T1DM patients was 0.20 μg/L,compared with 2.14 μg/L of 85 T2DM patients;the differences above were all statistically significant (Z =-11.127,P =0.00;x2 =27.689,P =0.000;x2 =18.473,P =0.000 017;x2 =47.348,P =0.000;Z =-12.865,P =0.00).Two hundred and seventy-nine T1 DM patients were tested for islet cell antibody (ICA),insulin autoantibody (IAA),glutamic acid decarboxylase antibody (GADA) at the same time,and the positive rate was 2.9％ (8/279 cases),14.7％ (41/279 cases),and 9.3％ (26/279 cases) respectively,and there were 65 cases (23.3％) with at least one positive result.One hundred and three T1DM patients were detected by the combination of 5 islet autoantibodies (ICA,IAA,GADA,islet antigen-2 antibody,Zinc transporter type 8 autoantibodies),and the positive rate of at least 1 antibody was 53.4％ (55/103 ca-ses),while 23 T2DM patients were tested for these five auto-antibodies,and the positive rate of at least 1 antibody was 13.0％ (3/23 cases),and the difference between 2 groups was statistically significant (x2 =12.325,P =0.000 447).Conclusions (1) The number of hospitalized diabetes of children and adolescents in our center was increasing gradually.(2) In the center's hospitalized diabetes patients,T1DM accounted for the most,T2DM took the second place,and there were minority of special type of diabetes.MODY accounted for the most part of special type of diabetes,and the main gene mutation was GCK gene mutation with type of MODY2.(3)T1 DM had the characteristics of early onset age,typical "three polys and one little" symptoms of diabetes,more ketoacidosis at onset,low fasting C peptide,fewer family history of diabetes compared with T2DM.(4)The combined detection of islet autoantibodies could improve the detection rate of T1DM.