الفهرس 
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Abstract
The aim of this study was to evaluate current health care services provided to patients with type 1 diabetes mellitus registered in Diabetology clinic, Children’s hospital of Ain-Shams University in terms of metabolic control and complications encountered as primary outcomes.
This cross-sectional study was conducted on all eligible patients attending Pediatric and Diabetology Unit, Children’s hospital, Ain Shams University, during the period between May 2017 and July 2018. Patients’ data was collected via the case record form of clinic including baseline and follow up examination and investigations. In addition, knowledge of 120 patients or parents was assessed via a questionnaire.
The mean age of patients was 12.63 ± 3.41(range 4-18) years with mean diabetes duration 5.54 ± 3.07 years. A bit higher percent of female patients (58.8%) was enrolled. Those with diabetes duration 5 years or more constituted 57.3%. Eighty-five and half percent of patients were of low social class. Only 9 patients were on insulin pump therapy, and 98.7 were on basal bolus therapy. Severe hypoglycemia was reported in 16.7%, whereas about a third 30.5% were admitted with DKA during the last year prior enrollment. the most common co-morbidities with T1D were hypothyroidism (1.9%) and celiac disease (1.3%). Five patients were Down syndrome who developed later T1D. BMI was normal in nearly half (49.9%) of patients, 38.8% were underweight, 9.4% were overweight and 1.9% were obese. Seventy-three % were pubertal in different stages, and only one patient had delayed puberty. Forty-five patients were on ACE inhibitors.
The mean HbA1c was 8.75 ± 1.94 %, with poor glycemic control as HbA1c in excess of 7% was found in most patients (86.9%). The mean number of blood glucose monitoring (SMBG) 2.43 ± 0.64 times/day. Hyperlipidemia was reported as borderline and high levels of total cholesterol in 15.8% LDL in 13%, and triglycerides in 6.2% of patients.
Boys and girls were comparable as regards age, social class, diabetes duration and insulin dose. Both acute and chronic complications occurred frequently in girls than boys. Mean BMI was significantly higher in girls. Mean total serum cholesterol was higher in girls. The protective lipid HDL was also higher in girls.
Patients older than 11 years, have got longer diabetes duration, bigger insulin daily dose, frequent acute and chronic complications, lower mean weight and height percentiles, higher BMI, and diastolic blood pressure. In addition, mean total serum cholesterol, LDL and triglycerides were significantly higher.
Patients with more than 5-year-diabetes duration have significantly higher cholesterol level (167.58 ± 38.02 versus 163.23 ± 35.54 mg/dl), higher LDL (100.23 ± 29.49 versus 95.70 ± 28.11 mg/dl), presence of celiac antibodies (5 cases versus 4 cases) and lower number of SMBG (2.24 ± 0.66 versus 2.58 ± 0.57 times/day), (p< 0.05).
Patients whose their HbA1c was > 7% were older, with lower mean HbA1c, lower HDL, and more frequent hypoglycemia
Patients with microvascular complications were older with longer diabetes duration, higher BMI, more frequent acute complications and abnormal lipid profile..
We found that there was positive correlation between HbA1c and cholesterol, HDL, LDL, and daily insulin dose. While a negative correlation was observed between HbA1c and severe hypoglycemia in the last year.
In both univariate and multivariate regression analysis, age<14 years, BMI <17.85 and HDL >44 mg/dl were associated with better HbA1c (glycemic control).