Type 1 diabetes in pre-school children – long-term metabolic control, associated autoimmunity and complications

Diabet. Med. 29, 1291–1296 (2012)

Abstract

Aims  To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6 years of age.

Methods  Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6 years (study group) and 220 patients at older than 6 years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared.

Results  The mean follow-up period was more than 8 years. For the study group, mean HbA_1c levels ranged from 64 mmol/mol to 66 mmol/mol (8.0–8.2%) until age 10 years, and then rose to 73 mmol/mol (8.8%). The HbA_1c levels were higher in the study than in the comparison group for comparable ages (P = 0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P = 0.03). Kaplan–Meier diagnosis rates of celiac disease, 10 years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank = 0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy.

Conclusions  Children diagnosed with Type 1 diabetes before the age of 6 years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6 years. For children diagnosed with Type 1 diabetes aged under 6 years, good metabolic control was achievable until age 10 years, after which it deteriorated. Higher HbA_1c levels observed in children diagnosed before the age of 6 years were associated with longer duration of disease.