Ameyaw Emmanuel, Asafo-Agyei Serwah B, Thavapalan Sumithira, Middlehurst Angela C, Ogle Graham D
Department of Child Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia.
World J Diabetes. 2017 Sep 15;8(9):429-435. doi: 10.4239/wjd.v8.i9.429.
To determine the clinical features of diabetes in children and adolescents in Ghana.
Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016.
One hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5- < 10 year, 45.6% 10- < 15 year and 30.0% 15- < 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean ± SD HbA1c at diagnosis was 12.7% ± 1.9% (115 ± 21 mmol/mol). Four have since died: Hypoglycaemia (2), recurrent DKA (1), osteosarcoma (1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage.
Type 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.
确定加纳儿童和青少年糖尿病的临床特征。
回顾性分析2012年2月至2016年8月在库马西Komfo Anokye教学医院儿科内分泌门诊就诊的所有新发糖尿病儿童和青少年的临床特征。
106例患者患有糖尿病。90例（84.9%）根据临床特征和家族史诊断为1型糖尿病，16例（15.1%）为2型糖尿病。1型糖尿病患者诊断时年龄范围为0.9 - 19.9岁，发病高峰年龄为12 - 13岁，3.3%的患者年龄小于5岁，21.1%为5 - 10岁，45.6%为10 - 15岁，30.0%为15 - 20岁。71.1%为女性。常见临床特征为多尿（100%）、多饮（98.9%）和体重减轻（82.2%）。平均BMI标准差为 -0.54，范围为 -3.84至2.47。60.0%的患者以糖尿病酮症酸中毒（DKA）就诊。9例患者起病时有感染（皮肤、脓肿、腿部溃疡）。诊断时HbA1c的均值±标准差为12.7%±1.9%（115±21 mmol/mol）。4例患者已死亡：低血糖（2例）、复发性DKA（1例）、骨肉瘤（1例）。另外2例1型糖尿病患者在儿科内分泌科医生诊治前于急诊就诊时死于DKA。包括这2例患者在内的粗死亡率为32.2/1000患者年。2型糖尿病患者81%为女性，发病年龄为9 - 19岁。平均BMI标准差为1.49，范围为 -0.87至2.61。43.8%的患者以DKA就诊。所有2型糖尿病患者均有黑棘皮病。总体而言，9.8%的患者家中没有冰箱，大多数使用陶罐蒸发冷却来储存胰岛素。
1型糖尿病女性居多且DKA发生率高。2型糖尿病也有发生。基于临床特征进行分型较为困难。社区和专业人员的意识有待提高。
