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Abstract Incidence of diabetes mellitus in paediatric age group is increasing, particularly in those under the age of 5 years. The HLA genes, specially DQ alleles, and insulin gene are major genetic determinants for T1DM. Clinical presentation of neonatal DM is indistinguishable from type 1 DM. Insulin therapy in infants with type 1 diabetes mellitus or other monogenic causes of diabetes mellitus is a challenge. This cohort study included thirty newly diagnosed Egyptian children with diabetes mellitus attending The Diabetes Endocrine and Metabolism Paediatric Unit at children{u2019}s hospital of Cairo University. History taking, clinical findings, management and glycemic control were studied and followed up for a period of 6 months. Molecular background was studied for all cases. Forty-five control subjects were recruited for comparison of HLA typing results. The study group were further subdivided into 3 groups according to age at presentation: group 1 (NDM <6 months), group 2 (infants 6 months to <2 years) and group 3 (toddlers {u2265}2 to {u2264}5 years). DKA was the most frequent mode of presentation (40%). Specific diabetes syndromes were clinically suspected in 4/6 children of group 1. MDI was efficiently used with significant lowering of HbA1c among group 3 (p= 0.038). 74%, 80% within range glucose readings among group 2, 3 respectively. Median height SDS significantly improved among both groups (p= 0.006, 0.003) respectively |