A retrospective case study of clinical profile of hospitalized children with type 1 diabetes mellitus at a tertiary health care center in northern India

BackgroundType 1 diabetes mellitus (T1DM) mostly presents as diabetic ketoacidosis (DKA) and is a common pediatric endocrine emergency. There is dearth of literature on clinical profile of T1DM from North India.Objectives1. To identify the clinical profile of patients admitted with T1DM at a tertiary care hospital. 2. To assess the predictors of adverse outcome in patients with T1DM.MethodsA retrospective case series. Clinical and laboratory data were analyzed from hospital records of all patients with confirmed diagnosis of T1DM using standard guidelines admitted in Department of Pediatrics, King George's Medical University, Hospital, Lucknow, from January 2010 to October 2012. Adverse outcome was defined as death or refusal for treatment.ResultsIn this duration of 34-month 40 patients were admitted. There were 22 (55%) females, 24 (60%) were <10 years of age (mean age 8.12 years ± 3.7), 32 (80%) of rural origin, 21 (52.5%) presented in winter season and majority of patients 32 (80%) were diagnosed in the current hospitalization. Symptoms observed were fever in 18 (45%), polyuria/polydipsia in 26 (65%), vomiting in 22 (55%), respiratory distress in 31 (77.5%) and altered sensorium in 22 (55%). History of abdominal pain and weight loss in 11 (27.5%), sluggishness in 7 (17.5%), diarrhea and seizure in 4 (10%) and visual problem in 3 (7.5%). Family history of T1DM was present in 2 (5%) patients. Acidotic breathing, dehydration and features of shock were seen in 33 (82.5%), 31 (77.5%) and 11 (28%) respectively. DKA was present in 37 (92.5%), of which 24/37 (64.9%) had severe DKA. All DKA patients received oxygen, IV fluid, insulin infusion by using standard guidelines. Adverse outcome was seen in 7 (17.5%) patients. Statistically significant clinical features and laboratory parameters associated with adverse outcome were fever (OR = 10.50; 95% CI = 1.12–97.9; p = 0.017), polyuria/polydipsia (OR = 6.66; 95% CI = 1.09–40.73; p = 0.026), capillary refill time >3 s (OR = 33.6; 95% CI = 3.29–342.2; p < 0.000), raised serum creatinine (p = 0.011) and leukocytosis (OR = 10.93; 95% CI = 2.16–55.24; p = 0.003) and use of vasopressors (OR = 93.0; 95% CI = 7.2–196.69; p < 0.000). The mean duration of hospital stay was 8.6 days ± 5.6.ConclusionMost of patients admitted here were newly diagnosed and majority presented with DKA. Adverse hospital outcome was associated with fever, polyuria/polydipsia, capillary refill time >3 s, raised serum creatinine and leukocytosis. Hence attempts must be made for early diagnosis and appropriate treatment of T1DM.