Pattern of Type I Diabetes Mellitus in Yemeni Children

Research Article

J Pediatri Endocrinol. 2017; 2(2): 1018.

Pattern of Type I Diabetes Mellitus in Yemeni Children

Ba-Saddik IA* and Aghbari NA*

Department of Paediatrics, Faculty of Medicine and Health Sciences, Aden University, Yemen

*Corresponding author: Ba-Saddik IA, Paediatric and Child Health Department, Faculty of Medicine & Health Sciences, University of Aden, Yemen

Received: August 19, 2017; Accepted: November 24, 2017; Published: December 01, 2017

Abstract

Type 1 diabetes mellitus is the most frequent endocrine- metabolic disorder of childhood and adolescents. It is an important public stressful current issue because of its long term adverse complications.

Objectives: To describe the clinical pattern, management and outcome of diabetes mellitus among Yemeni children in Aden.

Patients and Methods: All admitted children holding the diagnosis of Type 1 diabetes mellitus with or without diabetic ketoacidosis were included in this study during January1999 to December 2001 at Al–Sadaka paediatric teaching hospital, Aden, Yemen

Results: A total of 55 patients were admitted during the study period with sex variation of male to female ratio of 1.5:1. The mean age (SD) was 10.5 (3.2) and the peak age group was 10-14 years in 61.8% of the patients with the youngest male infant of 16 months. A positive family history was obtained in 9 patients. Under nutrition was evident significantly in 80% of our patients. The major complaints of polydepsia and polyuria were present in 72.2% of the patients. The mean (SD) hospital stay was 13.6 (7.3) days. All patients were treated with insulin. Diabetic ketoacidosis occurred in 11 patients of whom two unfortunately died.

Conclusion’s and Recommendations: Type 1 diabetes mellitus is a major health problem among Yemeni children. It is essential to establish a diabetic registry in Yemen and stress on importance of carrying out an epidemiological evaluation on type 1 diabetes mellitus. We recommend the provision of best health care services which should be available and affordable to every diabetic child.

Keywords: Type I Diabetes Mellitus; Ploydepsia polyuria; Diabetic Ketoacidosis; Insulin

Introduction

Type 1 Diabetes Mellitus (T1DM) is the most prevalent chronic endocrine-metabolic disorder of childhood and adolescence characterized by hyperglycemia which maybe acute and sometimes life-threatening [1]. T1DM can occur at any age and is characterized by the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells [2,3].

In 1997 the American Diabetes Association and WHO recommended altering the classification to define four main subtypes of Diabetes Mellitus (DM) [2]. T1DM includes immune mediated and idiopathic forms of β cells dysfunction which lead to absolute insulin deficiency. Type 2 Diabetes is a disease of adult onset which may originate from insulin resistance and relative insulin deficiency or from a secretory defect. Type 3 Diabetes covers a wide range of specific types of diabetes including the various genetic defect of β cells function, genetic defect in insulin action and disease of the exocrine pancreas. Type 4 Diabetes is gestational diabetes [2,4].

T1DM accounts for 5 – 10% of diabetes that usually occurs in children or young adults [3]. The peak incidence is during puberty and there is no sex predominance [1,4]. The seasonal variation peak onset is during the fall and winter [5]. Internationally rates of T1DM are increasing [6,7]. In Europe, the Middle East, and Australia, rates of T1DM are increasing by 2-5% per year [5,6,7]. Globally the incidence and prevalence of T1DM is highly variable among different Arab developing and developed countries [5,6]. A recent published review of the Nile Delta region in Egyptian children 0 to 18 years of age reported the prevalence of TIDM was 1.9, 15.5 and 26.8/100,000 in the years of 1996, 2006 and 2011 respectively [8]. In Iraq the estimated prevalence increased from 7.8 in 1995 to 14.2 in 2000 and to 24.7 in 2014 per 100 000 under 15 years old children [9]. In Eastern province of Saudi Arabia the incidence has doubled from 18.1 per 100,000 to 36.9 per 100,000 per year between 1990 and 2007 [10], while in Kuwait native children, the incidence increased from 17.7 per 100,000 per year (1992 to 1994) to 40.9 per 100,000 per year (2011 to 2013) [11].

Multiple factors are involved in the etiology of T1DM including genetic related to Human Leukocyte Antigen System (HLAS), environmental factors mainly viruses and immunological reactions [12,13]. The triggering factors are viral infections, early introduction of cow’s milk, non breast fed infants, antecedent stress, and exposure to certain chemical toxins [14,15].

In T1DM, 97% of patients present with the classical symptoms of polyuria, polydepsia, and polyphagia and weight loss. 10 – 20% initially present with frank Diabetic Ketoacidosis (DKA) with Kussmal respiration indicating acidosis, acetone on breath, with obtundation of consciousness or coma [16,17]. The revised diagnostic criteria for DM includes symptoms of DM plus random blood sugar > 200mg/dl (11.1mmol/L) or fasting plasma glucose > 126mg/dl (7.0mmol/) or 2-hour plasma glucose during oral glucose tolerance test > 200mg/dL [1,17].

T1DM is associated with long term damage, dysfunction or failure to various organs especially the eyes, kidneys, nerves, heart or blood vessels [1,3,4]. The acute complications are DKA and hypoglycemic reactions [3,16]. The chronic complications include retinopathy in 45 – 60% of >20 years disease and 20% after 10 years, nephropathy in 40% after 25 years disease and 50% of death in long term T1DM, with dwarfism and syndrome of limited joint mobility [17,18]. Long term management is a major challenge for child, family and health care team including education, insulin dosage, diet (nutritional requirement), exercise, stress management and blood glucose and urine ketone monitoring [1,2].

In Yemen there are no studies on childhood DM and the main objectives of this report is to highlight some baseline data on the clinical pattern, management, associated complications and outcome of TIDM among hospitalized children in Aden, Yemen.

Patients and Methods

All admitted children holding the diagnosis of T1DM with or without DKA were included in this study, during January 1999 through December 2001 at Al-Sadaka Teaching Hospital, Aden, Yemen. The patients’ demographic data, past history, clinical manifestations, investigations, management and outcome were obtained. Informed verbal consent was taken and ethical considerations was done by the hospital administration office. Data were entered into computer database SPSS Version 16 for windows. Statistical analysis included quantitative descriptive analysis as (Chi squares, Fischer exact test) and summary statistics (mean, percentages, and standard deviations).

Results

Overall 55 patients were holding the diagnosis of T1DM comprising a prevalence rate of 0.6% out of a total 9166 admitted patients during the study period. The male to female ratio was 1.5:1. The mean age (SD) was 10.5 (3.2). Sixty percent of the patients were admitted during the cool winter months. A higher proportion of the patients (47%) were from Aden governorate.

There was a documented consanguineous marriage with a positive family history of DM in 9 (16.4%) TIDM patients (Table 1). Five out of nine patients (55.6%) were of first degree relative and 4/9 children (44.4%) of second degree relative. There was a positive family history from male gender in 7/9 (77.7%), from father’s side in three patients (33.3%), one fraternal sibling (11%), two from grandfathers’ part (22.2%), one from grandmother’ side, one uncle and one aunt, each (11%) respectively. A higher proportion of patients 34 (61.8%) were diagnosed at peak age of 10-14 years with the youngest male infant of 16 months. Males with T1DM predominated in the three age groups of 0 – 4 years and 5 – 9 years and > 14 years while females outnumbered males in 10 – 14 years of age (Table 2). A significant difference of T1DM was observed between the different age groups and sex (p=0.04).