Dündar İsmail, Akıncı Ayşehan, Camtosun Emine, Çiftçi Nurdan, Kayas Leman, Nalbantoğlu Özlem
Department of Pediatric Endocrinology, İnonu University Faculty of Medicine, Malatya.
Department of Pediatric Endocrinology, İzmir Provincial Health Directorate S.B.Ü. Dr.Behçet Uz Children's Education and Research Hospital, İzmir, Turkey.
Turk J Pediatr. 2022;64(1):40-48. doi: 10.24953/turkjped.2020.3580.
The study aim was to examine changes in trends of presenting features during the diagnosis of patients followed up with newly diagnosed Type 1 diabetes mellitus (T1DM) over the past 24 years.
The study was retrospective. Patients with a diagnosis of T1D between the years of 1996-2019 were included. Patients diagnosed in the first half of the period comprised Period I, and those from the second half comprised Period II. Patient data were extracted from medical records and included gender distribution, year of diagnosis, age at diagnosis, duration of symptoms, type of admission, frequency of diabetic ketoacidosis (DKA) and biochemical parameters. Subsequently, temporal changes in trends of these parameters were sought.
For the whole cohort the gender distribution was equal; 404 (49.6%) were girls and 410 (50.4%) were boys. Mean age at diagnosis was 8.5±4.2 years and age groupings at presentation were: 23.2% (n = 189) aged 0-4; 39.2% (n = 319) aged 5-9; 27.5% (n = 224) aged 10-13; 10.1% (n= 82) aged 14-18. At presentation 72 (12.7%) had hyperglycemia, 230 (40.6%) had diabetic ketosis, and 264 (46.6%) had DKA. In those with DKA, mild DKA was found in 103 (39.0%), moderate DKA in 81 (30.6%), and severe DKA in 80 (30.3%). While the frequency of DKA was 54.9% between 1996 and 2007 (Period I), this significantly decreased to 44.4% between 2008 and 2019 (Period II). Girls and boys had a similar rate of T1DM, and this did not change over time. Three peak ages of diagnosis were evident; 5-7, 8-10, 12-14 years of age.
The frequency of DKA decreased and the frequency of admission with hyperglycemia and ketosis increased during the study period, which may have repercussions for mortality and morbidity rates and aid in improved treatment outcomes.
本研究旨在探讨过去24年中，新诊断的1型糖尿病（T1DM）患者在诊断过程中呈现特征的变化趋势。
本研究为回顾性研究。纳入1996年至2019年间诊断为T1D的患者。该时期前半段诊断的患者为第一阶段，后半段诊断的患者为第二阶段。从病历中提取患者数据，包括性别分布、诊断年份、诊断时年龄、症状持续时间、入院类型、糖尿病酮症酸中毒（DKA）频率和生化参数。随后，探寻这些参数趋势的时间变化。
整个队列的性别分布均衡；女孩404例（49.6%），男孩410例（50.4%）。诊断时的平均年龄为8.5±4.2岁，就诊时的年龄分组为：0 - 4岁占23.2%（n = 189）；5 - 9岁占39.2%（n = 319）；10 - 13岁占27.5%（n = 224）；14 - 18岁占10.1%（n = 82）。就诊时，72例（12.7%）有高血糖，230例（40.6%）有糖尿病酮症，264例（46.6%）有DKA。在有DKA的患者中，轻度DKA有103例（39.0%），中度DKA有81例（30.6%），重度DKA有80例（30.3%）。1996年至2007年（第一阶段）DKA的发生率为54.9%，2008年至2019年（第二阶段）显著降至44.4%。女孩和男孩的T1DM发病率相似，且未随时间变化。明显有三个诊断高峰年龄；5 - 7岁、8 - 10岁、12 - 14岁。
在研究期间，DKA的发生率下降，高血糖和酮症的入院发生率增加，这可能对死亡率和发病率产生影响，并有助于改善治疗效果。
