Li Guo-Hua, Huang Ke, Dong Guan-Ping, Zhang Jian-Wei, Gong Chun-Xiu, Luo Fei-Hong, Luo Xiao-Ping, Wang Chun-Lin, Zhu Min, Li Pin, Wang Ling, Fu Jun-Fen
The Children's Hospital of the Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Pediatrics, Shaoxing Maternal and Child Health Care Hospital, Hangzhou, China.
Front Pediatr. 2022 Jun 15;10:888370. doi: 10.3389/fped.2022.888370. eCollection 2022.
To investigate the clinical incidence and characteristics of type 1 diabetes mellitus (T1DM) of children and adolescents at the time of initial diagnosis in China.
Data on all pediatric patients with newly diagnosed T1DM were retrospectively collected from 34 medical centers in 25 major cities in China from January 2015 to January 2020. Patients were classified into three age groups: <5 years, 5 to <10 years, and ≥10 years of age. The same patient population was also categorized into diabetic ketoacidosis (DKA) and non-DKA groups based on clinical criteria.
The mean annual clinical incidence of T1DM was 3.16/100,000 from the years 2015 to 2019. A total of 6,544 patients with newly diagnosed T1DM aged 0-16 years (median 7.84 ± 3.8) were studied [ages <5 years (29.3%), 5 to <10 years (38.7%), and ≥10 years (32%)], 52.4% of them were women. In total, 90.5% of the cases were occurred in individuals without a family history. Patients had lower C-peptide (CP) and body mass index (BMI) z scores when compared with healthy children, 41.8% of them had measurable T1DM-related antibodies and 52.7% had DKA. Among all three age groups, the <5 years group had the lowest BMI z score, CP, and glycated hemoglobin (HbA1c) on average, while it had the highest incidence rate of DKA (56.9%). Compared to the non-DKA group, the DKA group was significantly younger, with a lower BMI z score and CP, higher antibody positive rate, HbA1c, and the rate of insulin pump therapy.
The clinical incidence of T1DM in children and adolescents in China was 3.16/100,000. Patients with DKA at the first diagnosis of T1DM have a worse β-cell function. Public health measures for the prevention and treatment of T1DM should focus on preschoolers (aged <5 years) in particular, considering the severity and the highest frequency of DKA in this age group. More efforts should be dedicated to early screening and diagnosis of the T1DM.
探讨中国儿童及青少年1型糖尿病（T1DM）初诊时的临床发病率及特征。
回顾性收集2015年1月至2020年1月中国25个主要城市34家医疗中心新诊断T1DM的儿科患者数据。患者分为三个年龄组：<5岁、5至<10岁和≥10岁。同一患者群体也根据临床标准分为糖尿病酮症酸中毒（DKA）组和非DKA组。
2015年至2019年T1DM的年平均临床发病率为3.16/10万。共研究了6544例0-16岁新诊断的T1DM患者（中位年龄7.84±3.8岁）[<5岁（29.3%）、5至<10岁（38.7%）和≥10岁（32%）]，其中52.4%为女性。总体而言，90.5%的病例发生在无家族史的个体中。与健康儿童相比，患者的C肽（CP）和体重指数（BMI）z评分较低，41.8%的患者有可检测的T1DM相关抗体，52.7%的患者有DKA。在所有三个年龄组中，<5岁组的平均BMI z评分、CP和糖化血红蛋白（HbA1c）最低，而DKA发病率最高（56.9%）。与非DKA组相比，DKA组明显更年轻，BMI z评分和CP更低，抗体阳性率、HbA1c和胰岛素泵治疗率更高。
中国儿童及青少年T1DM的临床发病率为3.16/10万。T1DM初诊时合并DKA的患者β细胞功能更差。考虑到该年龄组DKA的严重程度和最高发生率，T1DM的预防和公共卫生措施应尤其关注学龄前儿童（<5岁）。应更加努力地对T1DM进行早期筛查和诊断。
