Analysis Of Clinical Characteristics Of Hospitalized Patients With Type 1 Diabetes Mellitus At Different Onset Ages

Objective: The clinical data of patients with type 1 diabetes mellitus(type 1diabetes mellitus,T1DM)hospitalized in the Endocrinology Department of the first affiliated Hospital of Guangxi Medical University in recent 8 years were analyzed retrospectively.The incidence,biochemistry and complications of T1 DM patients in different onset ages were analyzed.The clinical characteristics of T1 DM patients in different onset ages were summarized,and whether there were differences in the influencing factors of diabetic ketoacidosis(Diabetes Ketoacidosis,DKA)in T1 DM patients of different onset ages.The purpose of this study is to provide a basis for targeted diagnosis and treatment of T1 DM in different age groups.Methods: This study collected 407 T1 DM patients who were hospitalized in the Endocrinology Department of our hospital from May 2012 to May 2020.According to the age of onset,the patients were divided into group A(<15 years old),group B(15-35 years old)and group C(>35 years old).According to the different rate of islet cell destruction,the rats were divided into two groups:acute type 1 diabetes group and adult latent autoimmune diabetes group((Latent autoimmune diabetes mellitus in adults,LADA).According to the presence or absence of ketoacidosis,the rats were divided into ketoacidosis group(DKA group)and non-ketoacidosis group(NDKA group).The incidence,biochemical indexes and complications of T1 DM patients with different onset ages were compared.SPSS25.0 statistical software was used for statistical analysis.Results:1、General information:(1)Sex: 238 males and 169 females,male: female= 1.4.(2)Age: the age of onset ranges from 6 to 66 years old,and the median age of onset is 35 years old.There were 42 cases(18 males and 24 females)in group A(<15 years old),165 cases(101 males and 64 females)in group B(15-35 years old),and 200 cases(119 males and 81 females)in group C(>35years old).(3)personal history and family history: 106 cases(26.0%)had a history of smoking,97 cases(23.8%)had a history of drinking,74 cases(18.2%)had a family history of diabetes,and 30 cases(7.4%)had a family history of hypertension.(4)typical "three more and one less" symptoms: 93 cases(22.9%)had typical "three more and one less" symptoms.(5)complications: there were158 cases of DKA(38.8%),48 cases of diabetic nephropathy(11.8%),82 cases of diabetic retinopathy(20.1%),115 cases of diabetic macroangiopathy(28.3%),142 cases of diabetic peripheral neuropathy(34.9%)and 7 cases of diabetic foot.2.Comparison of clinical characteristics among different age groups of onset:(1)comparison of basic characteristics: The positive rates of smoking and drinking history in group B(15-35 years old)> group A(< 15 years old),C group(> 35 years old)> group A(< 15 years old);BMI level: group B(15-35 years old)> group A(< 15 years old),C group(> 35 years old)> group A(< 15 years old),C group(> 35 years old)> group A(< 15 years old),C group(> 35 years old)> group B(15-35 years old).Diastolic blood pressure: group B(15-35 years old)> group A(< 15 years old),C group(> 35 years old)> group A(< 15 years old)(2)comparison of islet β-cell function: 60 min C peptide: group B(15-35 years old)> group A(< 15 years old),C group(> 35 years old)> group A(< 15 years old).(3)comparison of complications:The incidence of diabetic retinopathy in group C(> 35 years old)> group A(< 15 years old),C group(>35 years old)> group B(15-35 years old);the incidence of diabetic macroangiopathy in group C(> 35 years old)> group A(< 15 years old),C group(> 35 years old)> group B(15-35 years old);the incidence of diabetic peripheral neuropathy in group C(> 35 years old)> group B(15-35 years old)>group A(< 15 years old).The incidence of diabetic foot in group C(> 35 years old)was higher than that in group B(15-35 years old).3.Comparison between acute type 1 diabetes group and LADA group: The onset age,fasting C peptide,postprandial 2h C peptide,60 min C peptide,120 min C peptide and 180 min C peptide in the acute type 1 diabetes group were lower than those in the LADA group.The incidence of diabetic ketoacidosis,the incidence of typical "three more and one less" symptoms in the acute type 1diabetes group were significantly higher than those in the LADA group.4.Comparison between DKA group and NDKA group: univariate analysis showed that the positive rates of leukocyte,urine glucose,urinary ketone body,cysteine,glycosylated hemoglobin,fasting blood glucose,2-hour postprandial blood glucose and significant weight loss in DKA group were higher than those in NDKA group.The course of disease,serum sodium,serum chlorine and high density lipoprotein in DKA group were significantly lower than those in NDKA group.The results of multivariate binary Logistic analysis showed that urinary ketone body positive(OR 29.857)and glycosylated hemoglobin(OR 1.137)were independent risk factors for DKA in patients with T1 DM,and high density lipoprotein might be a protective factor for DKA in patients with T1 DM.Conclusion:1.In recent 8 years,there were more male than female patients with T1 DM in our hospital.Diabetic complications were diabetic ketoacidosis,diabetic macroangiopathy and diabetic peripheral neuropathy.2.The islet β-cell function of T1 DM patients before 15 years old is worse,and the incidence of diabetic retinopathy,diabetic macroangiopathy,diabetic peripheral neuropathy and diabetic foot is higher in T1 DM patients after 35 years old.3.Compared with LADA,patients with acute type 1 diabetes had earlier onset,more obvious symptoms,higher blood glucose,poor islet function and higher incidence of DKA.4.The higher the blood glucose level of T1 DM patients is,the worse the blood glucose control is,and the more likely it is to have DKA.5.High density lipoprotein may be a protective factor for DKA in patients with T1 DM.