Clinical and Laboratory Characteristics of Type 1 Diabetes in Children and Adolescents: Experience from a Medical Center

兒童及青少年第1型糖尿病之臨床表現及實驗室檢查結果：一醫學中心之經驗

丁瑋信(Wei-Hsin Ting) ； 黃琪鈺(Chi-Yu Huang) ； 羅福松(Fu-Sung Lo) ； 洪禎鎂(Chen-Mei Hung) ； 詹佳蓉(Chia-Jung Chan) ； 李欣蓉(Hsin-Jung Li) ； 林昭旭(Chao-Hsu Lin) ； 李宏昌(Hung-Chang Lee) ； 李燕晉(Yang-Jinn Lee)

《Acta Paediatrica Taiwanica》 48卷3期 (2007/06) Pp. 119-124

https://doi.org/10.7097/APT.200706.0119

摘要

背景：第1型糖尿病的發生率在近年來有上升的趨勢，尤其是在年紀小的兒童。為了探討18歲以下兒童及青少年第1型糖尿病發病時的初期症狀以及糖尿病臨床症狀清單是否有助於記錄的完整性，我們做了一回溯性的分析。
方法：我們針對西元1979年1月1日至2006年9月30日在馬偕醫院診斷或在其他醫院診斷3日內轉至本院18歲以下第1型糖尿病的病人進行回溯性的分析。1994年10月1日後，我們使用糖尿病臨床症狀清單來做記錄。我們將病人依性別、年齡、發病時是台發生酮酸症以及病人是台有糖尿病臨床症狀清單來進行分析。
結果：我們一共分析了304個病人，其中130個病人(43%)有糖尿病臨床症狀清單；146個病人為男生；98個病人於6歲以前發病；198個病人以糖尿病酮酸症來表現。有糖尿病臨床症狀清單的病人記錄到較多輕微且我們平時較容易忽略的症狀。發病年紀在6歲以下的病人有較高比例為男童、糖尿病酮酸症、近期病毒感染以及呼吸困難的情況，而且發病前症狀時間較短。有糖尿病酮酸症的病人其發病前症狀時間也較短。
結論：糖尿病臨床症狀清單有助於記錄平時容易忽略的輕微糖尿病症狀。發病年紀在6歲以下的病人有較短的症狀時間以及較高比例發生糖尿病酮酸症。

關鍵字

第1型糖尿病 ； 糖尿病酮酸症 ； 清單 ； 兒童

並列摘要

Background: The incidence of type 1 diabetes (T1D) is increasing rapidly worldwide, predominantly in younger individuals. We developed a checklist of all symptoms of T1D reported in the literature and compared the completeness of the recording of symptoms at initial presentation before and after the checklist was adopted.
Methods: We retrospectively reviewed the records of patients newly diagnosed with T1D from January 1, 1979 through September 30, 2006 to assess the presenting features and test the usefulness of a symptom checklist in evaluating the history on presentation. The checklist was incorporated into the records as of October 1,1994.
Results: Of the 304 patients identified, 130 (43%) had checklists in the charts. There were 146 (48%) boys, 98 (32%) who were diagnosed under the age of 6 years, and 198 (65%) presented with diabetic ketoacidosis (DKA). Records with a checklist noted diabetic symptoms that were subtle and easily ignored more often than records without the checklist. As compared with those diagnosed at an older age, patients diagnosed at ≦6 years were more likely to be male, have DKA and a shorter symptom duration, and report more episodes of preceding viral infection and dyspnea. Patients with DKA also had a shorter symptom duration.
Conclusions: A diabetic symptom checklist was helpful in identifying clinical diabetic symptoms and signs which were otherwise easily ignored. Younger children were more likely to have a shorter symptom duration and a higher incidence of DKA.

並列關鍵字

type 1 diabetes ； diabetic ketoacidosis ； checklist ； children