title: Type 1 diabetes in pre-school children--long-term metabolic control, associated autoimmunity and complications.
abstract: OBJECTIVE
  To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6 years of age.
  
  
  METHODS
  Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6 years (study group) and 220 patients at older than 6 years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared.
  
  
  RESULTS
  The mean follow-up period was more than 8 years. For the study group, mean HbA(1c) levels ranged from 64 mmol/mol to 66 mmol/mol (8.0-8.2%) until age 10 years, and then rose to 73 mmol/mol (8.8%). The HbA(1c) levels were higher in the study than in the comparison group for comparable ages (P = 0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P = 0.03). Kaplan-Meier diagnosis rates of celiac disease, 10 years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank = 0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy.
  
  
  CONCLUSIONS
  Children diagnosed with Type 1 diabetes before the age of 6 years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6 years. For children diagnosed with Type 1 diabetes aged under 6 years, good metabolic control was achievable until age 10 years, after which it deteriorated. Higher HbA(1c) levels observed in children diagnosed before the age of 6 years were associated with longer duration of disease.
authors.affiliation: Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Raanana, Israel. yael.levy.shraga@gmail.com
authors.forename: Y
authors.initials: Y
authors.lastname: Levy-Shraga
authors.forename: L
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: V
authors.initials: V
authors.lastname: Boyko
authors.forename: C
authors.initials: C
authors.lastname: Graph-Barel
authors.forename: K
authors.initials: K
authors.lastname: Mazor-Aronovitch
authors.forename: D
authors.initials: D
authors.lastname: Modan-Moses
authors.forename: O
authors.initials: O
authors.lastname: Pinhas-Hamiel
mesh_terms: D015551:Autoimmunity; D001786:Blood Glucose / Q000378:metabolism; D002446:Celiac Disease / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human