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Childhood insulin-dependent diabetes mellitus: initial presentation and management in the nineties
T Limbach1, A C Truttmann, P E Mullis
1Department of Pediatrics, University of Bern, Switzerland.
Insights
Pediatricians now often detect childhood diabetes mellitus as nonacidemic hyperglycemia. This shift means less initial fluid and insulin are needed for these young patients, improving management strategies.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Childhood diabetes mellitus historically presented with severe ketoacidosis.
- Current pediatric practice involves active screening for diabetes mellitus in ill children.
- Urinary dipstick testing is a common diagnostic tool for early detection.
Purpose of the Study:
- To evaluate the impact of current screening strategies on the initial presentation of childhood diabetes mellitus.
- To compare the clinical characteristics and management of acidemic versus nonacidemic children diagnosed with diabetes mellitus.
- To assess if diagnostic approaches influence the severity of presentation and treatment needs.
Main Methods:
- Retrospective chart review of 61 children newly diagnosed with diabetes mellitus between 1991 and 1996.
- Inclusion criteria: positive glucosuria, ketonuria, and capillary glucose >14 mmol/l.
- Patients were categorized into acidemic and nonacidemic groups based on blood pH.
Main Results:
- Twenty-six of 61 patients (43%) presented with nonacidemic hyperglycemia (blood pH ≥7.36).
- No significant differences were observed in age, polydipsia, polyuria, plasma glucose, or HbA1c between acidemic and nonacidemic groups.
- Acidemic patients required more fluid for rehydration and higher total insulin doses.
Conclusions:
- Childhood diabetes mellitus is increasingly diagnosed in a nonacidemic state due to early detection strategies.
- Nonacidemic hyperglycemia in children with newly diagnosed diabetes mellitus may require less aggressive initial fluid resuscitation.
- Management protocols for childhood diabetes mellitus should consider the nonacidemic presentation, potentially reducing initial fluid and insulin requirements.
Abstract:
Diabetes mellitus with onset during childhood usually presents as overt ketoacidemia. Pediatricians now inquire specifically about diabetes mellitus in children with nonspecific signs of illness and perform urinary dipstick testing. The present study was therefore performed to assess the possible influence of this strategy on the initial presentation and management of diabetes mellitus. The charts of 61 consecutive children with newly diagnosed diabetes mellitus (positive glucosuria and ketonuria and capillary glucose >14 mmol/l), who had been admitted between 1991 and 1996 at the Department of Pediatrics, University of Bern, Switzerland, were therefore reviewed. Twenty-six out of the 61 patients were nonacidemic (blood pH 7.36 or more). Children with and without acidemia did not differ with respect to age, history of polydipsia and polyuria, plasma glucose and circulating glycated hemoglobin A1c. The degree of dehydration and the amount of fluid required for its correction and the total insulin dosage were more prominent in the group of patients with acidemia. The study demonstrates that childhood diabetes mellitus is nowadays often recognized as nonacidemic hyperglycemia and that in these patients a reduced initial fluid repair and total insulin dosage is recommended.