CLINICAL AND LABORATORY CHARACTERISTICS OF TYPE-I (INSULIN-DEPENDENT)DIABETES-MELLITUS AT PRESENTATION AMONG BULGARIAN CHILDREN

Clinical and laboratory data of 1248 newly diagnosed diabetic children at the rime of diagnosis were analysed. All children were admitted to the University Children's Hospital in Sofia, 45.9%, before first thei r insulin injection. Symptoms preceding the diagnosis and laboratory d ata (plasma glucose and ketonuria) were analysed, respectively for 110 0 and 1022 children. Blood pH (mainly arterialized) was available in 5 58 ketonuria positive children and in other 82 acidotic breathing was reported. Mother's education was noted in the 1226 hospital records. A mong the children with known urinanalysis 13.5%, were without ketonuri a (148 patients), 12 of them with fasting blood glucose less than or e qual to 6.4 mmol/l (115 mg/dl). Eighteen-paint-two percent of all chil dren were hospitalized in a state of severe ketoacidosis (blood pH les s than or equal to 7.2 or reported acidotic breathing). The average du ration of thirst and polyuria was 28 +/- 33 days. Ketonuria negative c hildren with plasma glucose less than or equal to 6.4 mmol/l showed a significantly shorter period of symptoms, compared to those with plasm a glucose >6.4 mmol/l (17 +/- 25 vs. 25 +/- 31 days; P = 0.0991). The cases with severe ketoacidosis, compared to those with mild ketoacidos is (blood pH 7.21-7.34) showed shorter period of symptoms too (P = 0.0 658). Moderate positive relation existed between the age at diagnosis and duration of symptoms (chi(2) = 43.28, D.F. = 8, P = 0.0000). The p ercentage of severe ketoacidoses is higher in the younger age groups. Febrile illness, preceding the start of the symptoms was more common i n the groups with shorter duration of symptoms (up to 1 month), bur di d not change the proportion of severe ketoacidoses. No significant dif ference was found between the level of mother's education and duration of the symptoms before diagnosis (P = 0.9782) We concluded that the l evel of metabolic disturbances at the diagnosis of IDDM among children was not influenced by the duration of the preceding symptoms. The sev erity of clinical picture was possibly dependent on the degree of insu linopenia, i.e. the rate of beta-cell destruction. Clinical heterogene ity was possibly dependent on genetical heterogeneity related to HLA c lass II genes.