Doutreix J, Lévy-Marchal C
INSERM CJF 93-13, Hôpital Robert Debré, Paris.
Rev Epidemiol Sante Publique. 1996;44 Suppl 1:S90-6.
Prospective registry of newly diagnosed cases of insulin-dependent diabetes mellitus in subjects under 20 years began in 1988 in Aquitaine, Lorraine, Basse- and Haute-Normandie (population base = 2,288,018 inhabitants under 20). The registry gave a complete coverage of the population as the capture-recapture method gave a 98% yield. The mean annual incidence was 7.6/100,000 for the period 1988-1990. A specific survey aimed at describing clinical and biological presentation at diagnosis. The main symptom was polyuria in 98% of the cases, fatigue in 58% and weight loss in 44%. Abdominal pain was reported in 34% of the cases. Diagnosis was ascertained by measurement of plasma glucose, which was > or = 11 mmol/l in 95% of the cases and associated with ketonuria in 84% of the children. Coma in 13% of the children and acidosis (total CO2 < or = 18 mmol/l) in 48% showed the severity at diagnosis. Ketonuria and acidosis were significantly more frequent in the younger age group (0-4 yr). Diagnosis was made by a general practitioner in the majority of the cases; conversely insulinotherapy was initiated at the hospital in 95% of the cases. Initial insulin treatment was 2 daily injections. Following the French experience the collaborative network EURODIAB ACE has undertaken the same survey among the European Registries. Important geographical variations in incidence rates of IDDM in children has been reported across Europe but it is not known whether this interferes with presentation at diagnosis of the disease.
1988年起，在阿基坦、洛林、下诺曼底和上诺曼底地区（20岁以下人口基数为2288018人）开始了一项针对20岁以下胰岛素依赖型糖尿病新确诊病例的前瞻性登记。该登记实现了对人群的全面覆盖，因为捕获再捕获法的捕获率为98%。1988 - 1990年期间的年平均发病率为7.6/10万。一项专项调查旨在描述诊断时的临床和生物学表现。主要症状方面，98%的病例有多尿，58%有疲劳，44%有体重减轻。34%的病例报告有腹痛。通过测量血浆葡萄糖确诊，95%的病例血浆葡萄糖≥11 mmol/l，84%的儿童伴有酮尿。13%的儿童出现昏迷，48%有酸中毒（总二氧化碳≤18 mmol/l），显示出诊断时的病情严重程度。酮尿和酸中毒在较年轻年龄组（0 - 4岁）更为常见。大多数病例由全科医生做出诊断；相反，95%的病例在医院开始胰岛素治疗。初始胰岛素治疗为每日注射2次。借鉴法国的经验，欧洲糖尿病协作网络EURODIAB ACE在欧洲各登记处开展了相同的调查。据报告，欧洲儿童胰岛素依赖型糖尿病发病率存在重要的地理差异，但尚不清楚这是否会影响该病诊断时的表现。
