Background: Psychosocial factors and health events are important for patients with chronic diseases such type 1 diabetes (TD1).
Objective and hypotheses: The aim was to explore the psychosocial factors, health events and comorbidity found at diagnosis and during the follow up of children and adolescents with type 1 diabetes. Also to analyze the association between socioeconomic status and glycaemic control.
Method: Medical charts of children between 2 and 18 years old with type 1 diabetes were reviewed. All of them were type 1 diabetic patients followed by the Paediatric Endocrinology team in our hospital from 2010 to 2017. Diabetes care includes: 1 week of hospitalization at diagnosis, diabetological education, 56 outpatient visits per year, and phone or email support. Insulin regimen: 52 children with basal- bolus, with rapid-acting and long-acting insulin analogues, 3 children using continuous subcutaneous insulin infusion (CSII). All were instructed in carbohydrate counting. 18 (32.72%) children used continuous glucose monitoring system (CGMS).
Results: Fifty five TD1 children (19 girls (34.54%) and 36 boys); mean age at diagnosis 93.36±44 months, (range 21198); months of follow up were 61.41±41.83 (range 1168); 38 children were Spanish and 17 immigrants (30.90%), most from Morocco or Romania. Prediagnostic diseases were: 2 celiac disease, 2 thyroiditis, 2 IgA deficiency, 1 Down síndrome, 1 viral miocarditis, 3 preterm, 2 twins and 1 triplet. Six (10.9%) children had relatives with DM1 and 7 (12.72%) with tyroid autoinmunity. Diabetic ketoacidosis was found in 17 debuts (30.09%). Mean HbA1c at diagnosis was (11.2%±2.45) (range 5.316.2%). Mean Anti-GAD was 198±528 (range 02500). Follow up: Mean last HbA1c was (7.8%±1.25) (range 5.411.5%); 9 (16.36%) severe hypoglycemia occurred; 19 (34.54%) children were hospitalized after the debut (ketoacidosis, severe hypoglycemia, poor control or infectious diseases). In 8 cases (14.54%), family collaboration was insufficient; 8 (14.54%) children had poor school adjustment, and 2 has learning impairment (Down symdrome, limbic encephalitis). 12 (21.81%) adolescents had psychiatric or psychosocial problems. One girl had autoimmune limbic encephalitis with psychosis, intellectual disability and refractory epilepsy that improved with IV immunoglobulin. Six (10.9%) children had dyslipemia; 5 (9.09%) celiac disease; 7 (12.72%) thyroiditis (5 hypothyroidism); 6 (10.9%) microalbuminuria; none ocular involvement; 2 pancreatitis and 1 atrophic gastritis. Weight and height development were normal except 1 short stature and 5 overweigth. High socioeconomic status, not be an immigrant and CGMS, were significantly associated with better glycaemic control.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology