Type 1 Diabetes Mellitus in the First Years of Life - Onset, Initial Treatment, and Early Disease Course.
Exp Clin Endocrinol Diabetes
; 132(8): 432-442, 2024 Aug.
Article
in En
| MEDLINE
| ID: mdl-39142301
ABSTRACT
OBJECTIVE:
This study investigated the onset and the choice of treatment in children with very early onset of type 1 diabetes mellitus (T1D).METHODS:
The study included 5,763 patients from the German Diabetes Patient Follow-up registry with onset of T1D in the first 4 years of life from January 2010 - June 2022. The analysis included diabetes-specific parameters, anthropometric data, and mode of treatment at onset, within the first and second year of T1D. Three groups were compared according to age at onset (G1 223 patients 6-<12 months, G2 1519 patients 12-<24 months, G3 4001 patients 24-48 months).RESULTS:
In 12.3% of all cases in childhood and adolescence, the incidence of diabetes in the first 4 years of life was rare. At the onset, clinical status was worse and diabetic ketoacidosis (DKA) rates were higher in G1 and G2 (52.3% and 46.5%, respectively) compared to G3 (27.3% (p<0.001)). G1 and G2 were significantly more likely to be treated with insulin pump therapy (CSII) 2 years after onset (98.1% and 94.1%, respectively)) compared to G3 (85.8%, p<0.001). Median HbA1c after 2 years did not differ between groups (G1 7.27% (56.0 mmol/mol), G2 7.34% (56.7 mmol/mol) and G3 7.27% (56.0 mmol/mol)) or when comparing CSII vs MDI. The rate of severe hypoglycemia (SH) and DKA during the first 2 years of treatment did not differ among the three groups, ranging from 1.83-2.63/100 patient-years (PY) for DKA and 9.37-24.2/100 PY for SH. Children with T1D under 4 years of age are more likely to be diagnosed with celiac disease but less likely to have thyroiditis than older children with T1DM.CONCLUSIONS:
Young children with T1D had high rates of DKA at onset and were predominantly treated with insulin pump therapy during the first 2 years. The median HbA1c for all three groups was<7.5% (58 mmol/mol) without increased risk of SH or DKA. The use of continuous glucose monitoring (CGM) was not associated with lower HbA1c in children under 48 months.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Age of Onset
/
Diabetes Mellitus, Type 1
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
Exp Clin Endocrinol Diabetes
Year:
2024
Document type:
Article