Original articleCharacteristics at diagnosis of type 1 diabetes in children younger than 6 years
Section snippets
Study Design
After receiving authorization from the Committee on Clinical Investigation, we conducted a systematic retrospective chart review to obtain demographic information, clinical and family history, physical examination findings, and laboratory data at the time of presentation of new-onset T1D in children under age 6 years who presented to Children’s Hospital Boston (CHB) from January 1, 1990 through December 31, 1999 inclusive. Patients presented either to the emergency department (ED) directly or
Results
From 1990 to 1999, we identified 247 children under age 6 years who presented to CHB with new-onset T1D. The mean age at diagnosis was 3.4 ± 1.6 years and did not differ by gender. Age, gender, DKA status at presentation, and family history are given in Table I.
Nine percent of the children had a first-degree relative with T1D; 5.3% of the population had a father with T1D, and 2% had a mother with T1D. Racial or ethnicity data were obtained in 96% of the children. Among those who reported racial
Discussion
The results of this retrospective study concur with earlier observations that the diagnosis of T1D is often delayed.23, 24, 25 Our identification of a significant association between the duration of candidal infection to HbA1c at diagnosis underscores the importance of early recognition of candidiasis to detect the onset of T1D before it progresses to DKA.
The finding of comparable HbA1c levels across a 6-year age interval contrasts with previous reports 9, 11, 14 that younger children have a
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2021, Cognitive and Behavioral PracticeCitation Excerpt :The T1D diagnosis experience can be traumatic for parents, and many parents report feelings of fear, anger, guilt, helplessness, and grief (Whittemore et al., 2012). Young children are often critically ill at the time of diagnosis, with 44% of those under 6 presenting in diabetic ketoacidosis (DKA), a potentially life-threatening condition in which blood glucose is extremely elevated and bodily functions are compromised (Quinn, Fleischman, Rosner, Nigrin, & Wolfsdorf, 2006). Parents grapple with having a child with a disease that does not currently have a cure, and some experience feelings of guilt surrounding genetic influences related to T1D disease development (Lowes, Lyne, & Gregory, 2004; Mullins et al., 2004).
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2020, Canadian Journal of DiabetesCitation Excerpt :Five of 10 studies reported a higher frequency of severe DKA in children <2 to 3 years of age, and we do not think a clear answer can be given to this question based on the existing literature. There are several potential reasons why younger children could be at a higher risk of DKA, including 1) early symptoms of diabetes may be missed in young children because frequent voiding, vomiting and increased work of breathing are frequently observed symptoms in these patients, in association with other, more common conditions such as urinary tract infection, viral gastritis or respiratory tract infections (33); 2) younger children are less likely to have free access to fluids and may be more severely dehydrated and acidotic at presentation; 3) younger children are also more likely to have a concurrent infection (21) or febrile illness (22) at presentation, which may precipitate metabolic decompensation in children already at risk of diabetes (27) and 4) younger children are more likely to have higher islet autoantibody positivity, which may cause increased beta-cell destruction, leading to a more rapid and severe presentation (21). There are a number of limitations with this review.