c-peptide and Polyuria

Cases of type 1 diabetes mellitus in children aged younger than 6 years in Taiwan has increased in the past 10 years. This retrospective study aimed to review the management experience of such patients in a single center.. From January 2004 to June 2015, 52 newly diagnosed diabetic children younger than 6 years who had regular follow-up for > 1 year were enrolled, as well as 94 older diabetic children for comparison. Their medical records were thoroughly reviewed.. The most common symptoms and signs were polyuria, polydipsia, dry lips, weight loss, and nocturia. Among the children younger than 6 years, 87% had ketoacidosis upon diagnosis-significantly higher than that of the older age group-and 88% had at least one islet cell autoantibody detected. Their serum C-peptide levels were significantly lower and the frequency of insulin autoantibodies detected was significantly higher compared with the older age group (37% vs. 10%). The remission rate of the young diabetic patients was significantly lower than that of the older age group (40% vs. 59%), but there was no difference in time of onset and duration of remission between the two groups.. Autoimmune destruction of pancreatic β-cells is an important cause of type 1 diabetes mellitus in Taiwanese children aged younger than 6 years. These patients usually have a low insulin reserve and severe ketoacidosis upon diagnosis. A high index of suspicion in the presence of classic symptoms of diabetes in young children is important to prevent complications.

Topics: Adolescent; Age Factors; Autoantibodies; Blood Glucose; C-Peptide; Child; Child, Preschool; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; Humans; Lip; Male; Nocturia; Polydipsia; Polyuria; Symptom Assessment; Taiwan; Weight Loss

To analyze the time trend of the nationwide incidence of type 2 diabetes in children and adolescents < or = 15 years of age compared with type 1 diabetes between 1999 and 2007 in Austria.. In a prospective, population-based incidence study, all newly diagnosed patients with diabetes < or = 15 years of age were registered by the Austrian Diabetes Incidence Study Group. The Diabetes type was classified on the basis of clinical and laboratory findings according to ADA criteria. Time trends were estimated by linear regression models.. During the observation period, 1881 patients with type 1 diabetes and 34 patients with type 2 diabetes could be identified. Sixty-two percent of patients with type 2 diabetes were female, 56% had a positive family history for type 2 diabetes, and 74% presented with diabetes-specific symptoms. The incidence of type 1 diabetes in Austria increased from 12.0 to 18.4/100,000 (P < .001) and the incidence of type 2 diabetes remained stable below 0.6/100 000 (P = .706).. The incidence of type 2 diabetes in Austrian children is 10-fold lower than reported in other regions and did not increase over the last 8 years. During the same time period, a significant rise in the incidence of type 1 diabetes was observed.

Topics: Adolescent; Austria; Bacterial Infections; Blood Glucose; C-Peptide; Child; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Ethnicity; Female; Genetic Predisposition to Disease; Humans; Incidence; Male; Mycoses; Polyuria; Prospective Studies; Sex Distribution; Time Factors; Weight Loss

No consensus exists as to the best approach for treating markedly symptomatic patients with new-onset (or diet-treated) type 2 diabetes. Therefore, based on the experience of one successful case, further studies were undertaken to determine the safety and efficacy of maximal dose glyburide (10 mg, twice daily, in patients < 65 yr of age) or half the dose (10 mg, daily, in patients > or = 65 yr of age) for treating these patients. Fifty-five patients with polyuria, polydipsia, nocturia, involuntary weight loss, and blood glucose concentrations of 300 mg/dL or greater were treated following protocols that used maximal dose ( < 65 yr of age) or half-maximal dose ( > or = 65 yr of age) sulfonylurea agent therapy. Data were collected retrospectively in 30 patients and prospectively in 25. Patients in the prospective group differed only in that more laboratory measurements were obtained, and less strict guidelines for using insulin were adopted. Data were collected in both groups at baseline and 1 week and 4 months after starting the sulfonylurea agent therapy. Patients responded rapidly with a fall in blood glucose levels from 456 +/- 12 mg/dL at baseline to 202 +/- 10 mg/dL at 1 week to 120 +/- 5 mg/dL at 4 months. Glycated hemoglobin levels fell from 18.1 +/- 0.4% at baseline to 8.1 +/- 0.2% ( P < 0.0001) at 4 months. Most patients had symptomatic improvement within 3 days. Seventeen patients had positive (small or larger) urinary ketones, and 5 had positive serum ketones. Insulin to glucose and C peptide to glucose ratios improved maximally at 1 week, indicating rapid reversal of glucotoxicity on the beta-cell. At 4 months, 11 patients were receiving diet therapy alone, 29 were receiving submaximal dose sulfonylurea agent therapy, 6 remained on maximal dose sulfonylurea agent therapy, and only 3 were receiving insulin therapy. Six patients were lost to follow-up. No patient experienced hypoglycemia in the first 2 weeks of treatment. Maximal dose sulfonylurea agent therapy is a safe and effective method for treating patients with markedly symptomatic type 2 diabetes. Patients improve rapidly and are able to avoid the immediate institution of long term insulin therapy.

Topics: Adolescent; Adult; Aged; Blood Glucose; C-Peptide; Diabetes Mellitus, Type 2; Female; Glyburide; Humans; Hypoglycemic Agents; Insulin; Ketones; Male; Middle Aged; Polyuria; Prospective Studies; Retrospective Studies; Urination Disorders; Weight Loss

In order to characterize Type I diabetes at its clinical onset in French children, we studied HLA-DR alleles, beta-cell function and autoantibodies to islet-cell antigens and insulin in 115 patients aged 1.8-17 years. Beta-cell function was markedly impaired, but with an unexpectedly wide range of individual variations. These variations showed no correlation with HLA alleles or circulating autoantibodies, as opposed to observations made by others. Age, however, had a clear influence on the degree of impairment of residual insulin secretion, the younger children having the more deteriorated beta-cell secretory capacity conditioning the severity of clinical manifestations (weight loss, ketonuria, ketoacidosis) and initial hyperglycemia.

Topics: Adolescent; C-Peptide; Child; Child, Preschool; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; France; HLA-DR Antigens; Humans; Infant; Insulin Antibodies; Male; Polyuria; Weight Loss