EPIDEMIOLOGIC AND CLINICAL CHARACTERISTIC S OF TYPE-I INSULIN-DEPENDENT DIABETES-MELLITUS IN ITALIAN CHILDREN UNDER 3 YEAR-OLD

13 Italian clinics for Childhood Diabetes participated in a collaborat ive study aimed to assess personal and clinical data in children with type 1 (insulin-dependent) diabetes mellitus onset during the pre-scho ol years (0-3 yrs). Between January 1981 and December 1990, 220 patien ts under 3 year old on a total population of 1834 children aged 0-15 y rs were newly diagnosed giving an overall frequency of 12%. Compared w ith 404 children aged 6-9 yr at IDDM diagnosis (Group B), under 3 year olds (Group A) showed no significant difference in personal, familial and genetic characteristics, except for a more frequent history of mo rbidities during pregnancy and/or neonatal period. Autoimmune abnormal ities, such as positivity for auto-antibodies and selective IgA defici ency, were less evident in younger patients. IDDM onset in Group A was characterized by a shorter period of preceeding symptoms and a higher frequency of diabetic ketoacidosis than in Group B. Glycated hemoglob in, as well as insulin requirement, were similar in the two groups of children at diagnosis, but were higher 6-12 months after the onset in those of Group A. The remission phase was uncommon in Group A patients , which evidenced a higher frequency of severe hypoglycemic episodes d uring the first year course. Our data suggest that IDDM presenting in pre school years is a frequent condition, which requires special care because of its clinical features at onset and management difficulties during the follow-up.