Clinical features of type 1 diabetic children at initial diagnosis.

Clinical and laboratory data of 165 newly diagnosed diabetic children at Chang Gung Children's Hospital in Taiwan from 1993 to 2003 were analyzed. The age distribution was categorized as 0-1 years: 19 (11.5%), 2-4 years: 39 (23.6%), 5-9 years: 61 (37%), and 10-16 years: 46 (27.9%); the incidence showed spring/winter peak and a mid-summer trough but not statistically significant (chi2= 1.86, p=0.61). The most common symptoms on presentation were polydipsia, weight loss, polyuria, and fatigue. Very young diabetic children had a higher incidence of having dyspnea at presentation (p=0.029) and had significantly lower levels of C-peptide (p=0.0086) and HbA1c (p=0.0025). The prevalences of GAD antibody and insulin autoantibodies were 67% and 49%, respectively. Children with severe diabetic ketoacidosis (DKA) were younger at diabetes onset (p=0.36, not to the statistical significance), had a higher incidence of preceding febrile illnesses (p=0.05), lower T4 and T3 levels (p=0.0008, 0.02), and higher white blood cell counts (p=0.03) than the mild group. In conclusion, diabetes in very young children is not rare and is more associated with more severe insulin deficiency. Young age at diabetes onset and preceding febrile illness may provoke severe DKA. High alertness is necessary for prompt diagnosis and management.