Original article
Characteristics at diagnosis of type 1 diabetes in children younger than 6 years

https://doi.org/10.1016/j.jpeds.2005.10.029Get rights and content

Objective

To characterize the prodrome, presentation, family history, and biochemical status at diagnosis of type 1 diabetes mellitus (T1D) in children under age 6 years.

Study design

This was a retrospective chart review of patients hospitalized at diagnosis with T1D from 1990 to 1999 in a children’s hospital.

Results

A total of 247 children were hospitalized, 44% of whom presented in diabetic ketoacidosis (DKA). When stratified by 2-year age intervals, only total carbon dioxide (tCO2) was significantly lower in the youngest children (P = .02), and the duration of candidiasis was significantly longer in those children presenting in DKA (P = .004). Parents were more likely to recognize symptomatic hyperglycemia in children older than 2 years (P < .0001). Most parents sought care for their child suspecting that the child had diabetes; the other children were diagnosed when presenting with another concern. Only gender and tCO2 were significantly correlated with hemoglobin A1c (HbA1c); age-adjusted HbA1c was 0.64% higher in girls compared with boys (P = .045), and each 1-mmol/L decrement in tCO2 increased the age- and gender-adjusted HbA1c by 0.086% (P < .001).

Conclusions

A high proportion of children under age 6 years present critically ill at the diagnosis of T1D. When any of the classic symptoms of diabetes or a yeast infection is present, a serum glucose level should be measured.

Section snippets

Study Design

After receiving authorization from the Committee on Clinical Investigation, we conducted a systematic retrospective chart review to obtain demographic information, clinical and family history, physical examination findings, and laboratory data at the time of presentation of new-onset T1D in children under age 6 years who presented to Children’s Hospital Boston (CHB) from January 1, 1990 through December 31, 1999 inclusive. Patients presented either to the emergency department (ED) directly or

Results

From 1990 to 1999, we identified 247 children under age 6 years who presented to CHB with new-onset T1D. The mean age at diagnosis was 3.4 ± 1.6 years and did not differ by gender. Age, gender, DKA status at presentation, and family history are given in Table I.

Nine percent of the children had a first-degree relative with T1D; 5.3% of the population had a father with T1D, and 2% had a mother with T1D. Racial or ethnicity data were obtained in 96% of the children. Among those who reported racial

Discussion

The results of this retrospective study concur with earlier observations that the diagnosis of T1D is often delayed.23, 24, 25 Our identification of a significant association between the duration of candidal infection to HbA1c at diagnosis underscores the importance of early recognition of candidiasis to detect the onset of T1D before it progresses to DKA.

The finding of comparable HbA1c levels across a 6-year age interval contrasts with previous reports 9, 11, 14 that younger children have a

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