LA PREVALENCE HOSPITALIERE DU DIABETE TYPE 1 CHEZ LA POPULATION PEDIATRIQUE A L’EPH DE LAGHOUAT DURANT LA PERIODE DU 01-01-2017 AU 31-12-2021

Abstract

Introduction Type 1 diabetes is a severe disease of carbohydrate metabolism related to the destruction of the beta cells of the pancreas resulting in insulinopenia. Its incidence is increasing throughout the world. The main aim of this study was to determine the hospital prevalence and incidence of type 1 diabetes in the pediatric population hospitalized in the pediatric department at the mixed hospital of LAGHOUAT between 2017 and 2021. Materials and methods : This is a retrospective, descriptive study evaluating the prevalence as well as the incidence of type I diabetes and the clinical, biological, therapeutic and the follow up of the pediatric population hospitalized in the department of pediatrics at the mixed hospital of LAGHOUAT between 01st January 2017 and 31st December 2021. Results: A total of 84 patients were enrolled, with a mean age of 8.34 years ± 5.45. with a sex ratio of 1.17. All had type 1 diabetes on insulin. The hospital prevalence of type 1 diabetes in the pediatric population hospitalized in the department of pediatrics at the mixed hospital of LAGHOUAT between 2017 and 2021 was 27.78 per thousand hospitalized children. The mean hospital incidence between 2017 and 2021 was estimated at 4.9 per 1000 hospitalized children/year. The average annual growth rate of diabetes is 6.42% per year. Two peaks of seasonality in the discovery of type 1 diabetes were individualized, the most important in autumn in October with 31% of cases (n=23) and a second peak in spring in April with 28% of cases (n=21). The occurrence of an 134 autoimmune disease in the family was found in 05 patients. A 2nd degree parental consanguinity was noted in only 3.5% of cases (i.e. 03 children from a consanguineous marriage). Among the 74 newly diagnosed children, 81% (n=60) were in diabetic ketosis, of which 04 had an infection. In 15% of cases (n=11) the diagnosis of diabetes was made only at the ketoacidosis stage of which 01 case had a ketoacidosis coma. Their age ranged from 08 months to 13 years (mean age : 6.5 years). 04% of cases (n=3) were admitted for a cardinal syndrome without ketosis. The mean age of diabetes onset was 8.34 ±3.24 years with extremes ranging from 8 months to 15 years. In 11.15% (08 cases) of newly diagnosed patients, the diagnosis was made before the age of 4 years. The most affected age group was the early childhood found in 51.35% (n=38). The delay in diagnosis varied from 2 days to 2 months with an average of 11.26 days. This delay was significantly shorter for children aged from 01 to 04 years than for the others. On arrival, the average glycemic level was 3.62±0.54 g/L with extremes ranging from 2.15 g/L to 5.8 g/L with an average of 3.45 g/L in males and 3.82 g/L in females. Note that, acidotic children had a glycemic level ranging from 3.62 g/L to 5.8 g/L with a mean of 4.2±0.78 g/L. The mean HbA1c at diagnosis was 10.85±1.65%. This could increase with age. Insulin treatment was started at admission. The insulin used was regular insulin for all children. 03 children started directly with the basal-bolus or the 02-injections regimen. The most frequently used treatment regimen was the basal-bolus regimen in 96% of cases (n=81). The 02-injection regimen was rarely used found in only 03 children (04% of cases). Conclusion : Diabetes seems to be frequent in the pediatric department of the mixed hospital of LAGHOUAT with an overall hospital prevalence of 27.78 per thousand. Diabetic ketosis is the most frequent discovery circumstances. The basal-bolus therapeutic regimen remains the most widely used as it mimics human physiology and has proven its effectiveness in improving the prognosis of type 1 diabetes. Key words : Type 1 diabetes, Prevalence, incidence, ketosis, Insulin, complication, basal-bolus regimen.