Changing spectrum of diabetes mellitus in children: challenges with initial classification

Area of Science:

• Pediatric Endocrinology
• Metabolic Disorders
• Clinical Research

Background:

• Accurate initial classification of diabetes mellitus (DM) in children is crucial for appropriate management.
• Distinguishing between type 1 DM (DM1) and type 2 DM (DM2) in pediatric populations can be challenging.
• Misclassification can lead to delayed or incorrect treatment, impacting patient outcomes.

Purpose of the Study:

• To determine the frequency of initial misclassification of DM in children.
• To compare the presenting clinical features of DM1, DM2, and misclassified cases.
• To identify factors associated with misclassification in pediatric DM patients.

Main Methods:

• Retrospective analysis of 206 pediatric patients diagnosed with DM.
• Review of initial diagnostic data, including clinical presentation and laboratory values.
• Comparison of characteristics between DM1, DM2, and initially misclassified patients.

Main Results:

• 10% of studied patients required a subsequent change in DM classification.
• Misclassified patients were predominantly DM2, presenting with significantly higher mean HbA1c (13.35%) compared to correctly classified DM2 patients (8.83%).
• Diabetic ketoacidosis (DKA) was more prevalent in initially misclassified DM2 patients (58.82%) than in correctly classified DM2 patients (6.45%).

Conclusions:

• Initial DM classification in children frequently needs revision, with 10% of cases requiring reclassification in this study.
• DM2 patients are most susceptible to initial misclassification, often presenting with elevated HbA1c and DKA.
• Improved diagnostic criteria and increased clinical awareness are needed to reduce misclassification rates in pediatric DM.