Diabetologia

, Volume 37, Issue 1, pp 70–74 | Cite as

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

  • J. H. Pinkney
  • P. J. Bingley
  • P. A. Sawtell
  • D. B. Dunger
  • E. A. M. Gale
  • The Bart's-Oxford Study Group
Originals

Summary

We surveyed the clinical presentation, initial management and subsequent course of a prospectively registered, population-based cohort of 230 patients with Type 1 (insulin-dependent) diabetes mellitus diagnosed before age 21 years in the Oxford Regional Health Authority area in 1985 and 1986. Clinical details from the time of diagnosis were available on 219 patients. Thirty-four (16%) were in severe ketoacidosis with pH less than 7.10 or plasma bicarbonate less than 10 mmol/l, and 21 (10%) had mild to moderate ketoacidosis with pH 7.10–7.35 or plasma bicarbonate 10–21 mmol/l. One child died in ketoacidosis. Presentation in severe ketoacidosis was most common in children under age 5 years (p<0.05), and ketoacidosis of any degree was less frequent in older children (0.05< p<0.01) and those with a parent or sibling with diabetes (p<0.01). Within 4 years of diagnosis, 55 of 211 patients (26%) experienced severe hypoglycaemia, which in 31 (15%) led to one or more admissions. Readmission for unstable glycaemic control excluding acute hypoglycaemia occurred at least once within 1 year of diagnosis in 13% and within 4 years in 28%, and was more common in girls, in children aged less than 10 years at diagnosis, and those with a history of severe hypoglycaemia. A second cohort of 97 similar patients was recruited in 1990. The rates of admission at diagnosis (79%), severe ketoacidosis (13%) and mild to moderate ketoacidosis (13%) did not differ from the 1985/1986 cohort. Despite recent developments in diabetes management and a high level of clinical ommitment at participating centres, ketoacidosis remains a common presentation of childhood diabetes, and hypoglycaemia is unacceptably frequent in the years following diagnosis. Greater public and medical awareness of the presenting features of diabetes in young children is needed to reduce the frequency of ketoacidosis at presentation, while hypoglycaemia remains a major obstacle to good glycaemic control.

Key words

Type 1 (insulin-dependent) diabetes mellitus clinical presentation ketoacidosis hypoglycaemia 

References

  1. 1.
    Bingley PJ, Gale EAM (1989) The incidence of insulin-dependent diabetes in England: a study in the Oxford region 1985-6. BMJ 298: 558–560Google Scholar
  2. 2.
    Pease JC, Cooke AM (1951) The family doctor and diabetic coma. BMJ ii: 336–338Google Scholar
  3. 3.
    Hardie J, McPherson K, Baum JD (1979) Hospital admission rates of diabetic children. Diabetologia 16: 225–228Google Scholar
  4. 4.
    Hamilton DV, Mundia SS, Lister J (1976) Mode of presentation of juvenile diabetes. BMJ ii: 211–212Google Scholar
  5. 5.
    Pozzilli P, Andreani D (1990) Type 1 diabetes at presenta- tion: the scene changes. Diabetic Med 7: 762–763Google Scholar
  6. 6.
    Hamman RD, Cook M, Keffer S et al. (1985) Medical care patterns at the onset of insulin-dependent diabetes mellitus; association with severity and subsequent complications. Diabetes Care 8 [Suppl 1]: 94–100Google Scholar
  7. 7.
    Karjalainen J, Salema P, Ilonen J, Surcel H-M, Knip M (1989) A comparison of childhood and adult type 1 diabetes melli- tus. N Engl J Med 320: 881–886Google Scholar
  8. 8.
    Levy-Marchal C, Papoz L, de Beaufort C et al. (1992) Clinical and laboratory features of type 1 diabetic children at time of diagnosis. Diabetic Med 9: 279–284Google Scholar
  9. 9.
    Joslin EP, Root HF, White P (1927) Diabetic coma and its treatment. Med Clin N America 10: 1281–1305Google Scholar
  10. 10.
    uJapan, Poland, the Netherlands, and Pittsburgh Diabetes Research Groups (1990) How frequently do children die at the onset of insulin-dependent diabetes? Analyses of registry data from Japan, Poland, the Netherlands and Allegheny County. Diab Nutr Metab 3: 57–62Google Scholar
  11. 11.
    Tarn AC, Smith CP, Spencer KM, Bottazzo GF, Gale EAM (1987) Type 1 (insulin-dependent) diabetes: a disease of slow clinical onset · ? BMJ 294: 342–345Google Scholar
  12. 12.
    Bingley PJ, Gale EAM (1989) Rising incidence of IDDM in Europe. Diabetes Care 12: 289–295Google Scholar
  13. 13.
    Metcalfe MA, Baum JD (1991) Incidence of insulin dependent diabetes in children under 15 years in the British Isles during 1988. BMJ 302: 443–447Google Scholar
  14. 14.
    Jefferson IG, Smith MA, Baum JD (1985) Insulin dependent diabetes in under 5 year olds. Arch Dis Child 60: 1144–1148Google Scholar
  15. 15.
    Wilson RM, Clarke P, Barkes H, Heller SP, Tattersall RB (1986) Starting insulin as an outpatient, report of 100 consecutive patients followed up for at least one year. JAMA 256: 877–880Google Scholar
  16. 16.
    British Paediatric Association Working Party (1990) The or- ganization of services for children with diabetes in the United Kingdom: report of the British Paediatric Association Working Party. Diabetic Med 7: 457–464Google Scholar
  17. 17.
    Fishbein HA, Faich GA, Ellis SE (1982) Incidence and hospitalization patterns of insulin-dependent diabetes mellitus. Diabetes Care 5: 630–633Google Scholar
  18. 18.
    Egger M, Gshwend S, Davey Smith G, Zuppinger K (1991) Increasing incidence of hypoglycaemic coma in children with IDDM. Diabetes Care 14: 1001–1005Google Scholar
  19. 19.
    Bergada I, Suissa S, Dufresne J, Schriffin A (1989) Severe hy- poglycaemia in IDDM children. Diabetes Care 12: 239–244Google Scholar
  20. 20.
    Aman J, Karlsson I, Wranne L (1988) Symptomatic hypogly- caemia in childhood diabetes: a population-based questionnaire study. Diabetic Med 6: 257–261Google Scholar
  21. 21.
    Daneman D, Frank M, Perlamn K, Tamm J, Ehrlich R (1992) Severe hypoglycaemia in children with insulin-dependent diabetes mellitus: frequency and predisposing factors. J Pediatr 115: 681–685Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • J. H. Pinkney
    • 1
  • P. J. Bingley
    • 1
  • P. A. Sawtell
    • 1
  • D. B. Dunger
    • 2
  • E. A. M. Gale
    • 1
  • The Bart's-Oxford Study Group
  1. 1.Department of Diabetes and MetabolismSt Bartholomew's HospitalLondonUK
  2. 2.Department of PaediatricsJohn Radcliffe HospitalOxfordUK

Personalised recommendations