MODE OF PRESENTATION AND PROGRESS OF CHILDHOOD DIABETES-MELLITUS IN THE SULTANATE OF OMAN

We surveyed the clinical presentation, initial management and subseque nt course of a prospectively registered cohort of 60 children with ins ulin-dependent diabetes mellitus (IDDM) diagnosed before age 15 years in the Sultanate of Oman between January 1990 and December 1993. Clini cal details from the time of diagnosis were available on all the child ren. At diagnosis 9(15 per cent) presented with severe ketoacidosis (D KA) with pH less than 7.1 or plasma bicarbonate less than 10 mmol/l, a nd 16 (27 per cent) had mild to moderate ketoacidosis with pH 7.1-7.35 or plasma bicarbonate 10-18 mmol/l. During DKA electrolyte disturbanc es included: hyponatremia (K<3.5 mmol/l) (25 per cent), hyperkalemia ( K>5.5 mmol/l) (18 per cent) and hyponatremia (Na<130 mmol/l) (40 per c ent). Serum creatinine concentrations were high in 15 per cent of chil dren with DKA. Within the first year of diagnosis, 17 of the 60 childr en (28 per cent) experienced symptomatic hypoglycaemia, which in six ( 10 per cent) led to one or more admissions. Re-admission for unstable glycaemic control, excluding acute hypoglycaemia occurred at least onc e in six children (10 per cent) within 1 year of diagnosis and in 10 ( 17 per cent) within 2 years. Statural growth velocity (GV) and GVSDS ( 6.9 +/- 0.85 cm/year and 0.75, respectively) were significantly higher in the group of children with good glycaemic control (HbA1C = 7.9 +/- 0.4 per cent) compared to those children (3.7 +/- 0.44 cm/year and -1 .6, respectively) with bad glycaemic control (HbA1C = 12.5 +/- 1.5 per cent). Insulin-like growth factor-I (IGF-I) concentrations were signif icantly higher (260 +/- 21 ng/ml) in the group with good glycemic cont rol v. the group with bad control (149 +/- 15 ng/ml). In summary, grea ter public and medical awareness of the presenting features of diabete s in young children is needed to reduce the frequency of DKA at presen tation, and improvement of patient and family education is necessary t o reduce the incidence of DKA and hypoglycaemia in children with IDDM.