A. M. Al Rashed
Pattern of presentation in type 1 diabetic patients at the diabetes center of a university hospital
King Abdulaziz University|King Saud University
original articlepattern presentation type 1 diabetic patients diabetes center university hospital abdulaziz al rashedmd abdulaziz al rashed department pediatrics king abdulaziz university hospital college medicine king saud university riyadh saudi arabia search papers author published online2 jun 2011httpsdoiorg1041030256494781529sectionspdf toolsadd favoritesdownload citationtrack citations shareshare onfacebooktwitterlinked inredditemail aboutabstractbackground objectives diabetes mellitus dm major health problem worldwide study aimed investigate pattern presentation complications pediatric diabetesdesign setting retrospective study children treated diabetes clinic university hospitalfor diabetes 12year periodpatients methods collected data age onset sex clinical presentation duration symptoms diagnosis partial remission rate obtained hospital medical records national diabetes registry statistics departmentresults 369 diabetic children n321 children polyuria 92 32136987 presenting symptom symptoms included polydipsia 310 patients 888 31036984 weight loss 292 patients 839 nocturia 240 patients 688 24036965 diabetic ketoacidosis dka 174 patients 499 1743694720 abdominal pain 172 patients 493 174369466 presenting symptoms missing 20 files percentages calculated among 349 patients patients acute diabetic complications hypoglycemia 222 patients 62 dka 88 patients 381 none severe complications coma cerebral edema chronic complications included retinopathy 4 patients 13 neuropathy 2 patients 06 coronary heart disease 2 patients 06 nephropathy 1 patient 04conclusion pattern presentation type 1 diabetes changed incidence dka decreased unlike previous studies dka common presenting symptom study chronic complications diabetes retinopathy neuropathy coronary heart disease nephropathy mostly rare still present complications might prevented achieving better awareness need glycemic controlintroductiondiabetes mellitus dm major health problem worldwide current studies revealed definite global increase incidence prevalence diabetes world health organization projecting almost 221 million cases year 2010 285 million cases year 20251 fourth fifth leading cause death developed countries12 although increase mainly expected type 2 diabetes parallel increase childhood diabetes including type 1 2 diabetes reported3 dm children previously considered rare african asian populations48 diabetes mondiale diamond project group reported worldwide increase incidence variation 400fold type 1 diabetes highest occurring finland 45 per 100 000 children age 15 years lowest parts china fiji9dm children saudi arabia studied well studies needed10 little local information disease available cases reported type 2 dm11 epidemiology characteristics dm particularly insulindependent dm known saudi community small amount data available11 moreover data confirm need develop national registry need epidemiological research12 furthermore adolescents examined pediatric clinics receive adequate attention adult clinics13saudi arabia unique country among developing nations view excellent economic status relatively low literacy rate particularly among mothers addition cultural religious background might influence management diabetes14 presentation type 1 diabetes saudi children seems differ children western countries15 common clinical sign diabetic ketoacidosis dka observed 672 patients11 dka serious presenting symptom type 1 dm frequency severity dka presentation vary significantly worldwide16 saudi arabia studies revealed dka present 55 77 dm cases1517 ketoacidosis common presenting symptom childhood dm region18this study presents epidemiological clinical features complications childhood dm recorded diabetes center king abdulaziz university hospital riyadh saudi arabia diabetes center receives patients riyadh district suburban areas addition tertiary care center receives referred patients different cities country objective study investigate pattern presentation pediatric diabetes patients enrolled diabetes center university hospital review complications diabetes study grouppatients methodsall diabetic children enrolled study among treated king abdulaziz university hospital 12year period 1993 2005 vital data study extracted several sources including hospital medical records national diabetes registry statistics department data extracted experienced physician strict supervision author also checked consistency completeness extracted data recorded information included age onset sex nationality consanguinity clinical presentation duration symptoms diagnosis partial remission rate defined according criteria international study group diabetes children adolescents period freedom clinical symptoms diabetes insulin requirements 05 unitskgday absent minimal glycosuria 4 weeks study type 1 diabetes predominantly diagnosed basis clinical biological features polyuria polydipsia weight loss fatigability principal clinical features diagnosis significant hyperglycemia taken account biological feature according national diabetes data group criteria fasting blood glucose 140 mgdl 77 mmoll 2hour postprandial blood glucose level 200 mgdl 111 mmoll glycosuria without ketonuriaboth clinical biological features included diagnosis dka clinical features vomiting abdominal pain moderatetosevere dehydration stupor addition hyperglycemia blood glucose levels exceeding 15 mmoll ketonuria metabolic acidosis bicarbonate level 15 mmoll played significant roles determining dka chronic complications retinopathy nephropathy neuropathy identified ophthalmic findings indicative retinopathy persistent microalbuminuria abnormal nerve conductions respectively data analyses chi square tests fischer exact test performed using statistical packages stata r minitabresultsof 369 diabetic patients 159 431 patients 11 15 years age age groups 610 years 15 years consisted similar number patients100 271 97 263 patients respectively 13 35 patients less 5 years old mean standard deviation age 123 40 years range 218 years table 1 enrolled patients 175 474 male 194 526 female study group included 324 878 saudi patients 45 122 patients different arab nationalities positive family history dm recorded 260 737 patients including type 1 type 2 diabetes patients overall mean sd duration diabetes 46 37 years two major peaks age diagnosis one age 7 years 11 years sharp drop age 11 years curve almost reached plateau age 18 years figure 1 patients 134 patients 585 less 15 days duration symptoms diagnosis duration symptoms diagnosis ranged 1 365 days median 14 days table 1 mean total insulin intake 360 unitsd range 2106 unitsd median 37 unitsd partial remission observed 21 91 patients table 1 numbers patients age group duration diabetes family history diabetic complications 17 years age time diagnosis oldest patients study two peaks peaks age time diagnosis observed one early 12 days age case diagnosed another hospital referred diabetes center king abdulaziz university hospital three patients duration partial remission variables presented tables 2a 2b 2ctable 1 characteristics pediatric diabetic patients attending diabetes center university hospital 19932005 n369table 1 characteristics pediatric diabetic patients attending diabetes center university hospital 19932005 n369figure 1 distribution curve age diagnosis pediatric patients attending diabetes center university hospital 19932005download figuretable 2a sex pediatric diabetic patients age grouptable 2a sex pediatric diabetic patients age grouptable 2b sex age group duration diabetestable 2b sex age group duration diabetestable 2c sex age group duration family history diabetes diabetic complications duration partial remissiontable 2c sex age group duration family history diabetes diabetic complications duration partial remissionthe frequent presenting symptoms polyuria polydipsia weight loss nocturia table 3 dka present half table 3 missing data information parients available data fatigability available 231 patients fatigability observed 179 231 patients less frequent symptoms included fever obesity delayed wound healing vomiting loss consciousness diarrhea history preceding illness also less frequent ten 43 patients studied cohort asymptomatic patients acute diabetic complications hypoglycemia dka table 4 none patients severe complications coma cerebral edema chronic complications included retinopathy neuropathy coronary heart disease nephropathytable 3 symptoms pediatric diabetic patients presentation diabetes center according sex age group duration symptomstable 3 symptoms pediatric diabetic patients presentation diabetes center according sex age group duration symptomstable 4 diabetic complications acute chronictable 4 diabetic complications acute chronicdiscussionamong patients study diabetes diagnosed early 12 days age case diagnosed another hospital referred diabetes center king abdulaziz university hospital three patients 17 years age time diagnosis oldest patients study two peaks age time diagnosis observed one 7 11 years age study salman et al age onset ranged 75 months 12 years peak around 57 years 1114 years respectively second peak study observed occur age range similar reported abdullah 1013 years first peak observed occur slightly earlier 46 years1920 study abdullah youngest patient 6 months old diagnosisthe present study showed female preponderance 194 526 females versus 175 474 males female preponderance also observed series conducted salman et al wherein 536 patients female contrary series conducted abdullah showed male preponderance maletofemale ratio 131 ratio similar ratios observed uk denmark india1920 study duration symptoms diagnosis 135 days median 14 days compared duration 260 days mean 182 days series conducted salman et althe common clinical presentations present study polyuria 92 polydipsia 888 study salman et al dka common clinical presentation observed 74 673 patients present study dka observed 499 patients study abdullah 55 patients presented dka studies malaysia revealed figure 48 similar present study studies philippines india revealed figures 63 2040 respectively62122 dka considered uncommon japan indonesia2324 dka observed 499 patients series thus dka less common study local studies salman et al dka observed 672 patients abdullah dka observed 55 patients difference may explained higher level awareness among parents improvement health services early diagnosisthe partial remission rate study 91 lower rates observed studies abdullah 32 salman et al 309 correlates studies relation age group none patients 5 years age episode partial remission considered common diabetes diagnosed older children teenagers patients present study diagnosed less 11 years age figure 1 might explain low rate partial remission observed study lower incidence dka may explain low rate partial remissiona positive family history types 1 2 diabetes observed 737 patients study figure higher reported study abdullah 567 dm occurs significantly frequently parents siblings diabetics control population2526 study salman et al consanguinity rate family history type 1 2 diabetes higher reported literature also similar local study2529the treatment dm children requires provision comprehensive wellcoordinated continuous service best achieved teamwork adolescents young adults saudi arabia nonwestern countries examined pediatric clinics receive adequate attention adult clinics studies microvascular complications noninsulindependent dm patients suggest onset complications occurs least 46 years clinical diagnosis evidence shows strict glycemic control prevents microvascular complications30in summary incidence dka lower reported previous studies addition unlike previous studies dka common clinical presentation difference due better awareness early diagnosis additionally partial remission rate lower indicates early diagnosis although chronic complications uncommon children retinopathy neuropathy coronary heart disease nephropathy observed necessitates awareness among physicians caretakers patients importance early diagnosis strict control dm incidence family history higher reported previously explained higher rate consanguinity saudi community observation indicates need genetic studies dm saudi populationarticle references1 amos af mc carty dj zimmet p rising global burden diabetes complications estimates projections year 2010 diabet med 1997 14suppl 5s185 google scholar2 alberti kg zimmet pz diagnosis classification diabetes mellitus provisional report consultation diabet med 1998 1553953 google scholar3 silink childhood diabetes global prospective horm res 2002 5715 google scholar4 alberti kg world aspects diabetes diabetic med 1986 31035 google scholar5 lester ft childhood diabetes ethiopians diabet med 1986 327880 google scholar6 patel jc ohirawami mk kabun patel jc tawalker ng diabetes mellitus tropics 1968bombay diabetes association india6973 google scholar7 tsai sh baba goto fukui clinical 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