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A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children
Ling Hou1, Xiuzhen Li2, Li Liu2
1Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Diabetic ketoacidosis (DKA) is common in young children with type 1 diabetes mellitus (T1DM) in China. Significant challenges remain in T1DM treatment and follow-up for these pediatric patients.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition requiring lifelong management.
- Understanding the specific challenges in pediatric T1DM care within diverse healthcare systems is crucial.
Purpose of the Study:
- To investigate the clinical characteristics and current treatment status of children diagnosed with T1DM in China.
- To identify key challenges in the management and follow-up of pediatric T1DM patients across China.
Main Methods:
- A cross-sectional survey involving 1,603 children under 14 years old with T1DM.
- Data collected from 33 medical centers in 25 major Chinese cities between January 2012 and March 2015.
- Pediatric endocrinologists administered questionnaires to assess patient demographics, onset characteristics, and treatment details.
Main Results:
- Over half (52.03%) of pediatric T1DM patients presented with diabetic ketoacidosis (DKA), particularly younger children (mean age 7.12 years).
- Prevalence of autoantibody positivity (GADA, IAA, ICA) was noted at diagnosis.
- Treatment adherence varied, with 15.21% using insulin pumps, over 60% monitoring blood glucose less than 35 times weekly, and 4.74% facing insulin access issues.
Conclusions:
- Diabetic ketoacidosis (DKA) is a significant concern at diagnosis, especially in very young children with T1DM in China.
- Current treatment and follow-up protocols for pediatric T1DM in China face considerable challenges, including access to insulin and monitoring frequency.
Purpose:
To investigate the features and treatment status of children with type 1 diabetes mellitus (T1DM) in China.
Methods:
We recruited patients <14 years of age with T1DM from 33 medical centers in 25 major cities of China between January 2012 and March 2015. All patients completed a questionnaire that was conducted by their pediatric endocrinologists at all centers.
Results:
A total of 1,603 children (755 males and 848 females) with T1DM participated in this survey. Of these, 834 (52.03%) of the patients exhibited diabetic ketoacidosis (DKA) at onset, while 769 patients (47.97%) did not exhibit DKA (non-DKA) at onset. There was a higher proportion of females (55.71%) in the cohort of patients exhibiting DKA at onset than in the non-DKA cohort (49.33%). The mean age of patients exhibiting DKA at presentation was 7.12 ± 0.14 years; this was significantly younger than that in non-DKA group (7.79 ± 0.15 years; P < 0.005). The frequency of DKA in 3 years old, 3-7 years old, and 7 years old or more was 77.21%, 26.17%, and 37.62%, respectively. Upon initial diagnosis, 29.4%, 15.2% and 11.8% of patients showed positivity for glutamic acid decarboxylase antibody (GADA), Insulin autoantibodies (IAA), or islet cell antibody (ICA), respectively. During six months follow-up, 244 patients (15.21%) reported receiving insulin pump therapy, and more than 60% of patients monitored their blood glucose levels less than 35 times per week. Although the majority of patients had no problems with obtaining insulin, 4.74% of the children surveyed were not able to receive insulin due to financial reasons, a shortage of insulin preparations, or the failure of the parents or guardians to acquire the appropriate medicine.
Conclusion:
DKA is more common in very young children. Treatment and follow-up of T1DM in China still face very serious challenges.
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