Sadauskaite-Kuehne V, Samuelsson U, Jasinskiene E, Padaiga Z, Urbonaite B, Edenvall H, Ludvigsson J
Laboratory of Paediatric Endocrinology, Kaunas University of Medicine, Kaunas, Lithuania.
Diabetes Res Clin Pract. 2002 Mar;55(3):247-54. doi: 10.1016/s0168-8227(01)00328-x.
Severity of Type 1 diabetes mellitus (DM) at presentation was compared between south-east Sweden and Lithuania where incidence of childhood Type 1 diabetes is three times lower than in Sweden. New cases of diabetes at age 0-15 years from August 1995 to March 1999 in south-east Sweden and from August 1996 to August 2000 in Lithuania were included. Symptoms and clinical characteristics at diagnosis were recorded. Data about the close environment were collected using questionnaires. Lithuanian children were diagnosed in a more severe condition, mean pH 7.30 and HbA(1c) 11.5% compared with mean pH 7.36 and HbA(1c) 9.7% in Swedish children (P<0.0001). More Lithuanian than Swedish children were diagnosed in ketoacidosis (pH < or = 7.2, hyperglycaemia and ketonuria), 21.3 versus 7.3% (P<0.0001). Only 4.6% of Swedish children and 1.0% of Lithuanian children had no symptoms (P=0.007). Children in families with at least one first degree relative with diabetes (12.2% in Sweden and 8.4% in Lithuania, NS) had laboratory values at diagnosis closer to normal than sporadic cases in either country. Factors predicting ketoacidosis in Sweden were an unemployed mother and absence of infections in the 6 months before diagnosis. In Lithuania it was younger age and mother with less education. Additional educational activities for doctors are needed in countries with low incidence to reduce prevalence of ketoacidosis at onset.
对瑞典东南部和立陶宛1型糖尿病（DM）发病时的严重程度进行了比较，立陶宛儿童1型糖尿病的发病率比瑞典低三倍。纳入了1995年8月至1999年3月在瑞典东南部以及1996年8月至2000年8月在立陶宛0至15岁的糖尿病新发病例。记录了诊断时的症状和临床特征。通过问卷调查收集了有关周边环境的数据。立陶宛儿童被诊断出病情更为严重，平均pH值为7.30，糖化血红蛋白（HbA1c）为11.5%，而瑞典儿童的平均pH值为7.36，糖化血红蛋白（HbA1c）为9.7%（P<0.0001）。与瑞典儿童相比，更多的立陶宛儿童被诊断为酮症酸中毒（pH≤7.2、高血糖和酮尿症），分别为21.3%和7.3%（P<0.0001）。只有4.6%的瑞典儿童和1.0%的立陶宛儿童没有症状（P=0.007）。在父母至少有一方患有糖尿病的家庭中，儿童（瑞典为12.2%，立陶宛为8.4%，无显著差异）诊断时的实验室值比两国的散发病例更接近正常。在瑞典，预测酮症酸中毒的因素是母亲失业以及诊断前6个月没有感染。在立陶宛，是年龄较小和母亲受教育程度较低。发病率较低的国家需要为医生开展更多教育活动，以降低发病时酮症酸中毒的患病率。
