الفهرس | Only 14 pages are availabe for public view |
Abstract 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 production. 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. |