Factors Iinfluencing Onset and Metabolic Control in Children and adolescents with type 1 Diabetes Mellitus


Abstract:Background: Good glycemic control is crucial in preventing long - term diabetic complications.Objective: To determine the effect of a number of host & environmental factors on the onset and glycemic control of type 1 diabetes mellitus (DM1).Patients & methods: A total of 240 children and adolescents with type 1 diabetes mellitus (102 boys and 138 girls), their age range was 1.5 – 18 years, attending the Iraqi Diabetic Center / Al-Mustansiriya Medical College / Baghdad, were included in this cross – sectional study over a nine - month period, between 2nd of February and 3rd of November 2005.They had diabetes durations ranging from 3 months to 16.5 years. Clinical data ( age of onset, duration of diabetes, body mass index [BMI] which was measured and divided according to their percentiles into 6 levels [A-F] , insulin regimen, family history of diabetes, seasonality of clinical onset, consanguinity, sequence of birth ) and HbA1c level were recorded. Results: Patients presented no gender difference ( P>0.05), and prepubertal group has accounted for the highest percentage (53.8%), but Poor glycemic control was highly significant in the pubertal group ( HbA1c 9.61 + 2.19 %) [P<0.01). The overall HbA1c was 9.18 + 2.07 and the majority of BMI was located between group B(>75%) and group E (>10%). We found better metabolic control in patients with duration of diabetes below 2 years ( p < 0.05). Insulin regimen and BMI did not significantly affect HbA1c concentrations (P >0.05). Fifty two percent of the cases had a family history of diabetes & close consanguinity was present in (57.1%) of patients families.Conclusion: glycemic control was affected by age, duration but not by sex, family history, or insulin regimen & the onset was peaked during Summer months with higher prevalence among children born first.Keywords: type 1 diabetes mellitus, HbA1c, family history