Epidemiological Profile of type 1 diabetes in Children: about 971 Patients
Asmaa Khlifi*, Salma Farih and Zineb Imane
Department of Neurology-neurometabolism & Endocrino-diabetology, Children’s Hospital -CHU IbnSina, Morocco
Submission: June 02, 2019; Published: June 14, 2019
*Corresponding author: Asmaa Khlifi, Department of Neurology-neurometabolism & Endocrino-diabetology, Children’s Hospital -CHU IbnSina, Morocco
How to cite this article: Asmaa Khlifi, Salma Farih, Zineb Imane. Epidemiological Profile of type 1 diabetes in Children: about 971 Patients. Acad J Ped Neonatol. 2019; 7(5): 555778. DOI: 10.19080/AJPN.2019.07.555778
Diabetes is a chronic disease that is a public health problem. Its gravity is related to its acute and chronic complications. In children, this disease is becoming more and more common, with serious repercussions on the quality of life of the child, his family and his current and future health.
The purpose of our work is to describe the epidemiological profile of 971 patients admitted to our training between 2015 - 2018.
Keywords: Type 1 diabetes; Child; Age; Ketoacidosis
Diabetes is one of four priority noncommunicable diseases (NCDs) identified by WHO and could become the 7th leading cause of death worldwide by 2030 .
In Africa, 80% of people with diabetes are not diagnosed in time . Type 1 diabetes (T1D) remains by far the most common form of diabetes in children. The incidence of type I diabetes has steadily increased over the past two decades. This progression is particularly strong in younger children, leading to a rejuvenation of the age of discovery of diabetes and about 25% of diagnoses of type 1 diabetes are thus made in children under 5 years .
According to the Moroccan Minister of Health “About 2 million Moroccans over the age of 20 are diabetic, 50% of whom are unaware of this disease . The number of diabetics has increased
by 25% in 5 years from 2011 to 2015. Thus, 625,000 people receive treatment for diabetes in health centers, including 15,000
children with insulin-dependent type diabetes (T1D). Indeed, the main finding is that children under 15 years are increasingly affected by this disease .
We conducted a retrospective cross-sectional study of diabetes mellitus in children under the age of 16 over a 4-year period from January 2015 to December 2018.
The objective of this study is to define the epidemiological profile of the population of diabetic children identified in the endocrino-diabetology service at the Children’s Hospital - Ibn Sina University Hospital Center - Rabat.
Type 1 diabetes is a chronic disease diagnosed most often at a
young age (2/3 of cases before the age of 20) with an increase in
its worldwide incidence over the last twenty years, especially in
the youngest age groups .
According to the international project DIAMOND (World
Health Organization Project Childhood Diabetes) launched by
WHO in 1990, which aimed to monitor the incidence of T1D1 of
children under 15 between 1990 and 1999 in 112 centers out of
57 countries; A total of 43,013 cases were diagnosed in the study
population of 84 million children (4.5% of the world population),
an overall incidence of diabetes to 5/100,000 children per year.
It varies enormously between different countries, being higher
in Finland and Sardinia (Italy) (57.6/100000/year) and lower in
Venezuela and China (0.1/100000/year) .
An important epidemiological characteristic of the child’s
T1D is its mode of revelation, which is 40% that of ketoacidosis
according to the latest studies [7-8]. This situation due to a delay
in diagnosis may be life-threatening.
According to European data from the EURODIAB collaborative
group , the mode of developing ketoacidosis of diabetes in
children can reach 50% of the total revelation patterns in some
countries. The part of this mode of revelation must be reduced,
because at this stage it places the child in a situation of vital risk in
the short term, but also of deterioration of cognitive functions in
the longer term .
According to a nationwide study of T1D children from 2002
to 2016 .
Ketoacidosis revealed type 1 diabetes in 107 children, a
prevalence of 53%. This rate tends to decrease in other countries
and seems to reach 40% in France for example in 2014 .
This downward trend has also been observed in our Moroccan
population. From 68% in 2005, the proportion of diabetic
ketoacidosis recorded was less than 50% in 2016. This downward
trend is due to the many diabetes campaigns conducted in
T1D is most often found in the older child as evidenced by the
average age (7.25 +/- 1.5 years) in our series; with a frequency
peak observed around puberty (similar to the age group 9 to 15
years); indeed, many French and European studies have found it
since 1990 until 2015 .
In the worldwide DIAMOND study , under the auspices of
WHO, the sex ratio is 1.06. in the EURODIAB Study it is of the order
of 1.11 ; and in the Languedoc-Roussillon study conducted in
2015, the sex ratio is 1.09 .
The European study points out that there is a male
predominance in countries with a high incidence of diabetes (more
than 23/100,000 children per year) and a female predominance
in lower incidence countries (less than 4.5/100,000). children per
year), ie more girls in populations of African and Asian origin and
more boys in populations of European origin .
Our data match those described in the literature a sex ratio
(boy/girl) of 1.01 with a male predominance.
Regarding seasonal variations of T1D; the EURODIAB GROUP
has shown that the discovery rate of T1D is increased in autumn
and winter regardless of sex. This variation is much greater in
the 10-14 age group (+/- 24.9%) than in the 5-9 age group (+/-
19.8%) and in the 0-4 age group (+/- 8, 7%) , Another study
carried out on a Maghrebian scale objectified a fall detection rate
of T1D in the order of 40% of cases .
In our study, cases of T1D were more often diagnosed in the
fall, which is consistent with data found in the literature. (Chart 4)
This seasonal variation reinforces the hypothesis of a viral
origin of type 1 diabetes, with immediate effect (especially in
schools). However, the infection itself results in insulin resistance
and may accelerate metabolic decompensation in a child whose
beta cell function is impaired. The Finnish Diabetes Prediction
and Prevention study shows seasonal variations in the appearance
of diabetes-specific autoantibodies with a higher frequency in
Type I diabetes mellitus is a public health problem because
of its high frequency, particularly in recent years, where
environmental factors are mainly implicated in the onset of the
disease; It can occur at any age, but much more frequently in young
children or young adults who have just started their working
life. It is a condition occurring on a genetically predisposed field
whose prevention at the pre-diabetes stage must involve new
technologies of molecular biology.