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Abstract
The incidence of type 1 diabetes in younger age group is increasing all around the world. The incidence of childhood diabetes has increased in Europe and many other parts of the world over the past 20-30 years
Environmental factors encountered very early in life are likely to have been responsible for this increase, in genetically susceptible children
Diabetes in toddlers is characterized by its aggressive presentation, difficult control and higher occurrence of hypoglycemia
This was due to severe affection of B cell function detected by very low level of c peptide and higher blood glucose concentrations
Difficult management and poor glycemic control is due to un predictable food intake and physical activity, difficult administration of low doses of insulin and inability to convey symptoms of hypoglycemia to parents.
This work was carried out in the duration from September 1st 2005 to April 2006 It included 120 type 1 diabetes patients subdivided into two groups GROUP I this group included 60 type 1 diabetic toddlers and preschool children,32 males,28 females their ages ranged from 8 months to 5 years with mean of 3.5+ 1.9years ,mean age at diagnosis was 3.07+ 1.4years subdivided in 2 groups Group (IA) which included 20 type 1 diabetic patients aged < 5 years presenting in the period from from September 1st, 2005 to April 30th, 2006,and followed prospectively.Group (IB) which included 40 type 1 diabetic patients aged < 5 years studied retrospectively from the filing system of the Pediatric Diabetes Unit and followed in the period of the study They were diagnosed from period of January 1st,2000 to September 1st,2005
GROUP II, this group included 60 type 1 diabetic patients aged >5 years at diagnosis selected as case control to group I patients and diagnosed in the same months as group I patients,they were 30 males and 30 females,their ages ranged from 6 years to 19 years with mean 12.7+ 3.7 years,mean age at diagnosis 9.5+3years
It was subdivided into 2 groups Group (IIA). This group included 20 patients with type 1 diabetes mellitus >5 years at diagnosis. This group was followed prospectively in the period from September 1st,2005 to April 30th,2006,Group (IIB)This group included 40 patients with type 1 diabetes mellitus >5 years studied retrospectively from the filing system of the Pediatric Diabetes Unit, Children Hospital, Ain Shams University, and followed prospectively in the period of the study They were diagnosed from period of January 1st,2000 to September 1st,2005
Patients were subjected to full history with special emphasis on breastfeeding duration, time of cow milk & cereal introduction mode of presentation and complications
They were also subjected to thorough clinical examination; weight height and BMI were plotted against Egyptian centiles
In addition of RBS, mean insulin dose, HbA1cand C peptide were done initial and follow up after 6 months
The present study showed an increase in the number and percent of diabetic toddlers and preschool children in the last 5 years.
Results showed that Type 1 diabetes in toddlers was related to a number of environmental risk factor; eg.short duration of breast feeding ,early introduction of cow milk, early introduction of cereals ,viral infection at time of presentation especially with enteroviruses causing gastroenteritis.
There was also seasonal variation with diagnosis of more cases in winter and autumn.
The disease presentation in Diabetic toddlers and prescool children was aggressive with higher percent of DKA, they were also much more prone to occurrence of major hypoglycemia
Lab investigations showed decreased level of C peptide in diabetic toddlers at time of diagnosis when compared to other diabetic patients and increased level of RBS, mean insulin dose and HbA1c which indicated lower B cell reserve and difficult glycemic control with aggressive disease presentation.
In conclusion current study demonstrated role of environmental factors in triggering type 1 diabetes in toddlers and lower C peptide level at diagnosis which predicts more aggressive course of disease with difficult control.