Characteristics of Children with Newly Diagnosed Type 1 Diabetes Mellitus in Brunei Darussalam
DOI:
https://doi.org/10.15605/jafes.038.02.02Keywords:
type 1 diabetes mellitus, diabetic ketoacidosis, pediatricAbstract
Objective. This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger.
Methodology. A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam.
Results. A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p=0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0±14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018.
Conclusions. The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.
Downloads
References
Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology
and classification of diabetes in children and adolescents. Pediatr
Diabetes. 2009;10(Suppl 12):3-12. https://pubmed.ncbi.nlm.nih.gov/19754613.
https://doi.org/10.1111/j.1399-5448.2009.00568.x.
Laffel L. Ketone bodies: A review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26. https://pubmed.ncbi.nlm.nih.gov/10634967. https://doi.org/10.1002/(sici)1520-7560(199911/12)15:6<412::aid-dmrr72>3.0.co;2-8.
Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care. 2000;23(10):1516-26. https://pubmed.ncbi.nlm.nih.gov/11023146. https://doi.org/10.2337/diacare.
10.1516.
Shojaeian A, Mehri-Ghahfarrokhi A. An overview of the epidemiology of type 1 diabetes mellitus. Int J Metab Syndr. 2018;2(1):2-4.
Aguirre F, Brown A, Cho NH, et al. IDF Diabetes Atlas: Sixth edition. International Diabetes Federation; 2013.
Quinn M, Fleischman A, Rosner B, Nigrin DJ, Wolfsdorf JI. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr. 2006;148(3):366-71. https://pubmed.ncbi.nlm.nih.gov/16615969. https://doi.org/10.1016/j.jpeds.2005.10.029.
Pawłowicz M, Birkholz D, Niedźwiecki M, Balcerska A. Difficulties or mistakes in diagnosing type 1 diabetes mellitus in children? The consequences of delayed diagnosis. Pediatr Endocrinol Diabetes Metab. 2008;14(1):7-12. https://pubmed.ncbi.nlm.nih.gov/18577340.
Blanc N, Lucidarme N, Tubiana-Rufi N. [Factors associated with childhood diabetes manifesting as ketoacidosis and its severity]. Arch Pediatr. 2003;10(4):320-5. https://pubmed.ncbi.nlm.nih.gov/12818752. https://doi.org/10.1016/s0929-693x(03)00033-2.
Hochhauser CJ, Rapaport R, Shemesh E, Schmeidler J, Chemtob CM.
Age at diagnosis, gender, and metabolic control in children with type 1 diabetes. Pediatr Diabetes. 2008;9(4 Pt 1):303-7. https://pubmed.ncbi.nlm.nih.gov/18768035.
https://doi.org/10.1111/j.1399-5448.2008.00395.x.
Habib HS. Frequency and clinical characteristics of ketoacidosis at onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia.
Saudi Med J. 2005;26(12):1936-9. https://pubmed.ncbi.nlm.nih.gov/16380776.
Bowden SA, Duck MM, Hoffman RP. Young children (<5 yr) and
adolescents (>12 yr) with type 1 diabetes mellitus have low rate of partial remission: diabetic ketoacidosis is an important risk factor. Pediatr Diabetes. 2008;9(3 Pt 1):197-201. https://pubmed.ncbi.nlm.nih.gov/18547233. https://doi.
org/10.1111/j.1399-5448.2008.00376.x.
DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990-1999. Diabet Med. 2006;23(8):857-66.
https://pubmed.ncbi.nlm.nih.gov/16911623. https://doi.org/10.1111/j.1464-5491.2006.01925.x.
Lee WW, Ooi BC, Thai AC, et al. The incidence of IDDM in Singapore
children. Singapore Med J. 1998;39(8):359-62. https://pubmed.ncbi.nlm.nih.gov/9844497.
Hong Y, Hassan N, Cheah YK, Jalaludin MY, Kasim ZM. Management of T1DM in children and adolescents in primary care. Malays Fam Physician. 2017;12(2):18-22. https://pubmed.ncbi.nlm.nih.gov/29423125. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802777.
The Royal Children’s Hospital, Melbourne, Australia, Clinical Practice
Guideline on Diabetes Mellitus. Accessed May 10, 2018. https://www.rch.org.au/clinicalguide/guideline_index/Diabetes_mellitus/.
Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus
Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19(Suppl 27):155-77. https://pubmed.ncbi.nlm.nih.gov/29900641. https://doi.org/10.1111/pedi.12701.
Department of Economic, Planning and Statistics. Report of the mid-year population estimates 2018. Brunei Darussalam: Ministry of Finance and Economy;2018. https://deps.mofe.gov.bn/SitePages/Population.aspx.
Samuelsson U, Stenhammar L. Clinical characteristics at onset of
Type 1 diabetes in children diagnosed between 1977 and 2001 in the south-east region of Sweden. Diabetes Res Clin Pract. 2005;68(1):49-55. 15811565. https://doi.org/10.1016/j.diabres.2004.08.002.
Hekkala A, Knip M, Veijola R. Ketoacidosis at diagnosis of type 1 diabetes in children in northern Finland: temporal changes over 20 years. Diabetes Care. 2007;30(4):861-6. https://pubmed.ncbi.nlm.nih.gov/17392547. https://doi.org/10.2337/dc06-2281.
Ali K, Harnden A, Edge JA. Type 1 diabetes in children. BMJ. 2011;342:d294. https://pubmed.ncbi.nlm.nih.gov/21325386. https://doi.org/10.1136/bmj.d294.
Variation and trends in incidence of childhood diabetes in Europe.
EURODIAB ACE Study Group. Lancet. 2000;355(9207):873-6. https://pubmed.ncbi.nlm.nih.gov/10752702.Erratum in: Lancet 2000 Nov 11;356(9242):1690.
Ong SK, Lai DTC, Wong JYY, et al. Cross-sectional STEPwise approach
to surveillance (STEPS) population survey of noncommunicable diseases (NCDs) and risk factors in Brunei Darussalam 2016. Asia Pac J Public Health. 2017;29(8):635-48. https://pubmed.ncbi.nlm.nih.gov/29082745. https://doi.org/10.1177/1010539517738072.
Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacolone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. Diabetes Care. 199;22(1):7-9. https://pubmed.ncbi.nlm.nih.gov/10333896. https://doi.org/10.2337/diacare.22.1.7.
King BR, Howard NJ, Verge CF, et al. A diabetes awareness campaign
prevents diabetic ketoacidosis in children at their initial presentation
with type 1 diabetes. Pediatr Diabetes. 2012;13(8):647–51. https://pubmed.ncbi.nlm.nih.gov/22816992. https://doi.org/10.1111/j.1399-5448.2012.00896.x.
Gann H, Modgil G. How effective was the national ‘4T’s’ diabetes
awareness campaign for a local paediatric population and did specific
interventions reduce admissions for DKA? Endocr Abstr. 2014;36:
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chun Yen Wee
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
