| Objective:1.To summarize the clinical characteristics of type 1 diabetes mellitus in infants and preschool children in our hospital from 2015 to 2021.2.The differences in clinical characteristics between the two age groups were analyzed to provide references for precise treatment of diabetes,reduction of short-term and long-term complications,and more scientific management of patients.Methods:The clinical data of 180 infants and preschool children diagnosed with incipient T1 DM in our hospital from January 2015 to December 2021 were collected and retrospectively analyzed.The differences in clinical characteristics were analyzed and summarized according to age groups.Result:1.1 Epidemiological characteristics of the two groups1)incidence rate:During the 7-year period from January 2015 to December 2021,our hospital treated 180 new infants and preschool children with T1 DM,including 77cases（42.8%,77/180）in the infant group and 103 cases（57.2%,130/180）in the preschool group.The average annual incidence rate in the infant group was2.29/100000,fluctuating from 1.36 to 3.05/100000;The average annual incidence rate of preschool age group was 2.94/100000,fluctuating from 1.44 to 4.86/100000.In addition,the incidence rate of the infant group showed a downward trend during the epidemic period,while the incidence rate of the preschool group showed an upward trend.2)Gender,birth weight,place of residence,season of onset: There was no significant difference between the two groups（P both>0.05）.Although there was no statistical difference between the two groups in the season of onset（P=0.911）,they were mainly in winter and spring,accounting for 57.1% and 56.3% respectively,with the most in November.In addition,the season of onset of T1 DM during the epidemic showed different characteristics,and there were differences between the two groups.During the epidemic period,the infant group: spring and autumn（61.9%,13/21）was higher than summer and winter（38.1%,8/21）,with the highest in April（23.8%,5/21）.During the epidemic period,the preschool group: autumn and winter（60.6%,20/33）was higher than spring and summer（39.4%,13/33）,and the most in November（18.2%,6/33）.1.2 Comparison of general conditions between the two groups1)Clinical characteristics:（1）History of previous infection: The proportion of proinfection history in infant group was higher（28.6% in infant group and 6.8% in preschool age group）,and there was statistical difference between the two groups（P<0.001）.（2）Onset symptoms: The typical diabetes symptoms（polydipsia,polyuria,polyophagia and weight loss）were the main symptoms in the preschool age group,and there were statistical differences between the two groups（P all <0.05）;The main symptoms of the infant group were nervous system symptoms（depression,drowsiness,irritability,fatigue）and infection symptoms（fever）.There was statistical difference between the two groups（P<0.001 both P<0.05）.（3）The time from symptom onset to diagnosis: The time from symptoms to diagnosis was shorter in the infant group [8（5,15）days and 15（10,30）days in the infant group and preschool group respectively],and there was statistical difference between the two groups（P<0.001）.（4）Co-infection during the course of the disease: The proportion of infectious diseases in infant group was higher（58.4% in the infant group and 35.0%in preschool age group）,and there was statistical difference（P<0.05）.（5）Co-infection of the two groups before and during the epidemic: Before the epidemic,the respiratory tract infection was higher in the infant group（58.9% and 33.3%respectively）,with statistical difference（P<0.05）;In the preschool group,respiratory tract infection was higher（21.4% and 36.4% respectively）,but the difference was not statistically significant（P=0.108）.（6）ketoacidosis: The incidence of diabetes ketoacidosis（DKA）was higher in the infant group（79.2% and 48.5% respectively）,and there was statistical difference（P<0.001）.（7）Euthyroid sick syndrome（ESS）: The proportion of infants combined with ESS was higher（49.4% and 22.3% respectively）,and there was statistical difference（P <0.001）.In addition,in the occurrence of DKA,the proportion of infants combined with ESS was higher（59.0% and 38.0%respectively）,and the difference was statistically significant（P <0.05）.2)Nutritional status:（1）Nutritional level: There were 54 cases in the two groups,including 21 cases in the infant group and 33 cases in the preschool group.There were differences in nutritional levels between the two groups,and there were more low nutritional levels in the infant group（the infant group was at the middle,lower middle,Inferior levels,while some of the preschool group were at the middle,lower middle,Inferior levels,some were at the upper middle and superior levels）,but there was no significant difference between the two groups（P=0.139）.Further comparing the nutritional status of the two groups with or without DKA,it was found that compared with the non DKA group,the nutritional status of the DKA group in the two groups was worse [the nutritional level of the DKA group in the infant group was inferior,lower middle and middle while the nutritional level of the non DKA group was only middle,and the difference was statistically significant（P=0.024）.The nutritional level of DKA group in preschool group was inferior,lower middle,middle and upper middle level,while the nutritional level of non DKA group in preschool group was lower middle,middle,upper middle and superior level,the difference is statistically significant（P =0.022）].（2）Nutritional indicator: In the two groups,the body weight,albumin and prealbumin values of DKA group were lower,and the difference was statistically significant（P<0.05）;In the infant group,the hemoglobin of DKA group was lower than that of non DKA group（P< 0.05）;In the preschool group,the hemoglobin of DKA group was slightly lower than that of non DKA group,but the difference was not statistically significant（P> 0.05）.3)Laboratory indicators at initial diagnosis:（1）Glycometabolism: a Glycosylated hemoglobin The level of glycosylated hemoglobin（Hb A1c）was higher in the preschool group（Hb A1 c levels in the two groups were 11.1（9.9,12.5）and 12.3（10.7,14.0）respectively）with statistical difference（P<0.001）;b Fasting plasma glucose The level of fasting plasma glucose（FPG）in the infant group was higher（the FPG levels of the two groups were 17.9（14.1,27.0）and 13.0（10.6,18.9）respectively）,which was statistically different（P <0.001）.（2）Lipid metabolism: the levels of total cholesterol（TC）and low-density lipoprotein（LDL）in infant group were higher,and the difference was statistically significant（P<0.05 and P<0.001）;The level of triglyceride（TG）was higher and the level of high-density lipoprotein（HDL）was lower in the infant group,but the difference was not statistically significant（P>0.05）.（3）Pancreas β Cell function: the level of fasting C-peptide（FC-P）in the preschool group was higher（the levels of FC-P in the two groups were0.08（0.06,0.15）and 0.12（0.08,0.18）respectively）with statistical difference（P<0.001）.（4）Autoantibody: the positive rate of islet cell antibody（ICA）in infant group was higher（13.0% and 3.9% respectively）,and the difference was statistically significant（P<0.05）;The positive rates of glutamic acid decarboxylase antibody（GADA）,tyrosine phosphatase antibody（IA-2）and insulin autoantibody（IAA）in infant group were higher than those in preschool group,but the difference was not statistically significant（P all >0.05）.Conclusion:1.There are differences in the clinical characteristics between the two age groups.The onset of T1 DM in infants is hidden and acute,and the clinical manifestations are not typical,mainly nervous system symptoms and infection symptoms,while the clinical manifestations of T1 DM in preschool children are typical diabetes symptoms.2.Compared with preschool children,infants with T1 DM are more prone to infection and DKA.3.Children with DKA are more prone to metabolic disorders,such as altered thyroid function.Therefore,we should pay more attention to metabolic disorders in children with DKA.4.Compared with preschool children,infants with T1 DM have lower nutritional level,but there is no significant difference between the two age groups.5.After the infection rate decreased during the epidemic period,the infant morbidity is decreased,while the incidence of preschool children is increased,suggesting that infection has a greater impact on infant morbidity.Therefore,the focus of prevention for different age groups should be different,and through targeted prevention,the initial age of T1 DM may be delayed. |
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