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Type 1 diabetes is one of the most common endocrine diseases
in children. Worldwide, an estimated 65, 000 children under
15 years old develop the disease each year, and the global
incidence in children continues to increase at a rate of 3% a year.
It is known that age, the degree of glycemic deterioration
and the immune status at the time of the onset of T1DM are
objective factors that can predict the residual B-cell function and
the glycemic control after diagnosis.
Thus the aim of the present observational study was to
relate the clinical and laboratory characteristic present at the time
of diagnosis of T1DM to the prognosis of the disease in terms of
glycemic control and insulin requirements.
An observational retrospective study included 200 Pediatric
diabetic patients recruited from Diabetes Clinic- Pediatrics
Hospital- Ain Shams University Hospitals from 2003 to 2013.
Regarding demographic data of the studied cohort recruited
from our center, 60% were male. Mean age at onset of diabetes
was 7.19±3.64 years. The mean c-peptide level at onset was
0.20±0.09 ng /ml, mean HbA1c 7.3±1.12 %.53% of patients
presented with diabetic ketoacidosis (DKA).The mean insulin dosage at onset was 0.90±0.40.Thirty seven
(37.5%) were given insulin glargine (lantus) as their basal insulin at
onset of diagnosis, whereas 62.5% were given NPH.
Results from this observational study, regarding prognosis
of disease, concluded that female sex, younger age, Presence of
diabetic ketoacidosis, lower pancreatic reserve as evidenced by Cpeptide
and higher HbA1c levels at onset could predict a poor
long-term clinical outcome of T1DM in terms of insulin
requirements and glycemic control.
Patients who had received more vigorous treatment
immediately at disease onset had both a higher incidence of postinitial
remission and better diabetes control. Their results suggest
that rapid glycemic normalization after diagnosis of diabetes
increases the possibility of preserving some endogenous insulin
Glycated hemoglobin is the important clinical outcome
measured during the remission phase, and indeed when the
remission phase is defined as a low insulin dose, near normal
glycemia with minimal glycosuria, then glycated hemoglobin has
been observed to be similarly reduced. Therefore, the strong association we found between
achieving the target HbA1c during follow-up and the HbA1c
levels in the first year of diabetes emphasizes the importance of
attaining the target as early as possible, which may facilitate
diabetes control also beyond the remission. It may also reflect that
establishment of good habits early may predict long-term
compliance and adherence with therapy, especially in young
patients, when parents are usually the principal caregivers.