Quinn Maryanne, Fleischman Amy, Rosner Bernard, Nigrin Daniel J, Wolfsdorf Joseph I
Division of Endocrinology, Children's Hospital Boston, MA 02115, USA.
J Pediatr. 2006 Mar;148(3):366-71. doi: 10.1016/j.jpeds.2005.10.029.
To characterize the prodrome, presentation, family history, and biochemical status at diagnosis of type 1 diabetes mellitus (T1D) in children under age 6 years.
This was a retrospective chart review of patients hospitalized at diagnosis with T1D from 1990 to 1999 in a children's hospital.
A total of 247 children were hospitalized, 44% of whom presented in diabetic ketoacidosis (DKA). When stratified by 2-year age intervals, only total carbon dioxide (tCO(2)) was significantly lower in the youngest children (P = .02), and the duration of candidiasis was significantly longer in those children presenting in DKA (P = .004). Parents were more likely to recognize symptomatic hyperglycemia in children older than 2 years (P < .0001). Most parents sought care for their child suspecting that the child had diabetes; the other children were diagnosed when presenting with another concern. Only gender and tCO(2) were significantly correlated with hemoglobin A1c (HbA1c); age-adjusted HbA1c was 0.64% higher in girls compared with boys (P = .045), and each 1-mmol/L decrement in tCO(2) increased the age- and gender-adjusted HbA1c by 0.086% (P < .001).
A high proportion of children under age 6 years present critically ill at the diagnosis of T1D. When any of the classic symptoms of diabetes or a yeast infection is present, a serum glucose level should be measured.
描述6岁以下儿童1型糖尿病（T1D）诊断前的前驱症状、临床表现、家族史及生化指标。
这是一项对1990年至1999年在一家儿童医院诊断为T1D并住院的患者进行的回顾性病历审查。
共有247名儿童住院，其中44%以糖尿病酮症酸中毒（DKA）就诊。按2岁年龄间隔分层时，最年幼的儿童仅总二氧化碳（tCO₂）显著降低（P = 0.02），且DKA患儿的念珠菌病持续时间显著更长（P = 0.004）。2岁以上儿童的父母更有可能识别出有症状的高血糖（P < 0.0001）。大多数父母因怀疑孩子患有糖尿病而带其就医；其他儿童在出现其他问题时被诊断。仅性别和tCO₂与糖化血红蛋白（HbA1c）显著相关；与男孩相比，女孩的年龄校正HbA1c高0.64%（P = 0.045），tCO₂每降低1 mmol/L，年龄和性别校正后的HbA1c增加0.086%（P < 0.001）。
6岁以下儿童在T1D诊断时多病情危重。当出现任何糖尿病经典症状或酵母菌感染时，应检测血糖水平。
