title: Epidemiology and management of type 1 diabetes mellitus at the ain shams university pediatric hospital.
abstract: Type 1 diabetes mellitus is the most common metabolic disease in childhood. An interplay between genetic susceptibility and environmental factors (triggering or suppressive) may account for the pathogenesis of type 1 diabetes The diabetes control and complications trial (DCCT) showed the importance of strict metabolic control in delaying and preventing complications. The aim of this work was to describe the epidemiological features of type 1 diabetes mellitus (the pattern of seasonality at birth and at diagnosis, the initial symptoms of presentation, and the precipitating factors) and to compare the frequency of occurrence of long term complications (as microalbuminuria, and diabetic neuropathy and retinopathy) in relation to different insulin regimens among children attending pediatric hospital at Ain Shams University. This descriptive study was conducted on 416 patients of type 1 diabetes mellitus at pediatrics hospital, Ain Shams University. For each patient a questionnaire form was filled in through an interview with the patients and/or their parents and clinical examination was performed. Also, data were collected retrospectively from the patients' medical records. There was evidence of seasonality at diagnosis with overall predominance at summer. Also, seasonality at birth was clearly evident where 48.3% of cases were delivered during summer season. Polyuria and polydepsia were the most common presenting symptoms, 90.14% and 80.04% respectively. About 60.57% of cases were presented by Diabetic Ketoacidosis (DKA). As regards the precipitating factors, infection preceded the diagnosis of 21.9% of cases, while psychological trauma was evident in 8.7% of cases. Frequencies of occurrence of long term complications were 9.6% for microalbuminuria, 2.4% for hypertension, 1.4% for orthostatic hypotension, 4.1% for diabetic retinopathy, and 3.1% for diabetic neuropathy. These complications were more frequent with conventional insulin regimen in comparison to the intensive regimen and the difference was statistically significant.
  
  
  CONCLUSIONS
  Seasonal pattern was evident at diagnosis and at birth which is more common during summer. Diabetic children on intensive insulin therapy were experienced less long term complications than those on conventional regimen.
  
  
  CONCLUSIONS
  Longitudinal studies are required to confirm the presence of seasonality at birth and at diagnosis including control from normal population .Intensive diabetes therapy should be encouraged among children with type 1 diabetes mellitus to delay onset of long term complications.
authors.affiliation: * Community Medicine Department,Faculty of Medicine, Ain-Shams University, Egypt. nanees_gad@yahoo.com.
authors.forename: Nanees A
authors.initials: NA
authors.lastname: Ismail
authors.forename: Omar M
authors.initials: OM
authors.lastname: Kasem
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abou-El-Asrar
authors.forename: Mona H
authors.initials: MH
authors.lastname: El-Samahy