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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 1  |  Page : 305-310

Prevalence of diabetes mellitus among school-age children


1 Department of Pediatrics, Faculty of Medicine, El-Talaba Hospital, Menoufia University, Menoufia, Egypt
2 Department of Pediatrics, El-Talaba Hospital, Menoufia University, Menoufia, Egypt

Date of Submission30-Apr-2017
Date of Acceptance18-Jun-2017
Date of Web Publication17-Apr-2019

Correspondence Address:
Ibrahim N. T. Ganh
Sarsamous, El-Shohada, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_324_17

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  Abstract 


Objective
The aim of this research was to study the prevalence of diabetes mellitus (DM) among school-age children in Menoufia governorate.
Background
DM is a metabolic disorder of multiple etiologies. Type 1 DM can occur at any age, but it is most common in juveniles. Its importance is detected from the number of patients and new cases acquiring it. Estimation of its prevalence could be used to study its varied etiology, and the effect of inheritance and environment in its genesis.
Patients and methods
In all, 8000 school-age children from rural and urban areas in Menoufia governorate aged between 6 and 15 years between September 2015 and September 2016 had been subjected to filling a written questionnaire based on criteria of WHO (2010) for diagnosis of DM, and detection of glucose in urine (Glucotest), as well as estimation of random blood glucose for children with positive glucotest.
Results
A total of 300 children showed positive data suggesting DM in the written questionnaire, 35 children gave positive glucose in urine, 30 were newly diagnosed diabetics (18 urban and 12 rural; 20 male and 10 female; 26 with positive family history of type 1 DM and 14 with positive consanguinity), and five were false positive for glucotest. Therefore, the overall prevalence of juvenile DM was found to be 3.75/1000.
Conclusion
The prevalence rate of juvenile DM among school-age children in Menoufia governorate was 3.75/1000.

Keywords: blood glucose, child, prevalence, type 1 diabetes mellitus


How to cite this article:
Hassan FM, Khatab AA, Abo El-Fotoh WM, Ganh IN. Prevalence of diabetes mellitus among school-age children. Menoufia Med J 2019;32:305-10

How to cite this URL:
Hassan FM, Khatab AA, Abo El-Fotoh WM, Ganh IN. Prevalence of diabetes mellitus among school-age children. Menoufia Med J [serial online] 2019 [cited 2019 May 20];32:305-10. Available from: http://www.mmj.eg.net/text.asp?2019/32/1/305/256103




  Introduction Top


Type 1 diabetes mellitus (T1DM) is a chronic illness characterized by the body's inability to produce insulin because of the autoimmune destruction of the β cells in the pancreas. Onset often occurs in childhood, but the disease can also develop in adults in their late 30s and early 40s [1].

T1DM results from the interaction of genetic and environmental factors that alter the immune system and culminate in the destruction of the pancreatic β cell [2].

As the diagnosis of T1DM often occurs in childhood, age and maturation of that patient bring an elevated risk of developing microvascular (diabetic retinopathy, nephropathy, and neuropathy) and macrovascular complications [3].

The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers for type 1 and 2 diabetes, highlighting recommendations that are most relevant to primary care. The abridged version focuses particularly on prediabetes, self-management education, nutrition, physical activity, smoking cessation, psychosocial care, immunizations, glycemic treatment, therapeutic targets, diagnosis and treatment of vascular complications, and intensification of insulin therapy in type 2 DM [4].

A recent study of incidence and prevalence of T1DM in children and adolescents in three Egyptian governorates (Fayoum, North Sinai, and Suez) showed a prevalence rate of 0.7/1000 and an incidence rate of 4.01/100 000 [5].

The aim of this research was to study the prevalence of diabetes mellitus (DM) among school-age children in Menoufia governorate.


  Patients and Methods Top


This study was approved by Ethical Committee of Menoufia Faculty of Medicine and an informed consent was taken from the guardian of each participant.

This survey was done on 8000 school-age children in Menoufia governorate at the age range of 6–15 years between September 2015 and September 2016 to estimate the prevalence of DM in this age group. The studied children were enrolled from 10 schools: four urban (4000 children) and six rural (4000 children).

Procedures

In this study, we aimed to screen glucose in urine besides filing a written questionnaire suggesting the clinical data of DM in children, and if the urinary glucose was detected we verified its level in the blood. In addition, the growth pattern of diabetic children was studied and compared with normal children.

These children have been subjected to the following:

First stage

A written questionnaire based on criteria of WHO (2010) was filled for the diagnosis of DM by the child or his parents, focusing on the following:

The family history of T1DM.

History of consanguinity.

Symptoms and signs of DM.

These children were then subjected to the detection of glucose in urine using Medi-Test for rapid detection of glucose in urine (Macherey-Nagel, Düren, Germany).

Second stage

Children with positive glucotest were subjected to estimation of random blood glucose by using Hoffman Auto-Analyzer (Hoffmanla Roche, Basel, Switzerland) and other diagnostic tests for the diagnosis of DM.

Third stage

The following investigations were performed for diabetic children:

Complete blood count for hemoglobin, red blood cells, white blood cells, and platelets by using DIRUI BCC-3000B Hematology analyzer (Diamond Diagnostics, Holliston, Massachusetts, USA).

Glycosylated hemoglobin was assessed by using BioSystems S.A. (Barcelona, Spain).

Statistical analysis

Data were coded and transformed into specially designed form to be suitable for computer entry process. Data were entered and analyzed by using statistical package for social science (released 2011, IBM SPSS Statistics for Windows, version 20.0; IBM Corp., Armonk, New York, USA) [6].

Quantitative data were presented by mean ± SD. Data were analyzed using Student's t-test for comparison between two means. Qualitative data were presented in the form of frequency distribution tables, number and percentage. They were analyzed by χ2-test. However, if an expected value of any cell in the table was less than 5, Fisher's exact test (if the table was four cells) or likelihood test was used (if the table was more than four cells). Level of significance was set as P value less than or equal to 0.05 for all significant tests.


  Results Top


Among 8000 studied schoolchildren, the majority were girls (52.8%), whereas 47.2% were boys. In all, 50% were living in urban areas and 50% in rural areas. Their mean age was 11.3 ± 2.8 years [Table 1].
Table 1: Demographic profile of studied schoolchildren

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Prevalence of diabetes among schoolchildren was 3.75/1000; all cases were newly diagnosed. There was no significant difference between diabetic and nondiabetic children regarding mean age and residence [Table 1].

Family history of T1DM and consanguinity were highly associated with the occurrence of diabetes. Schoolchildren who had a positive family history of T1DM are more likely to develop diabetes at this young age by ∼18 times than schoolchildren who had a negative family history of T1DM. Schoolchildren who had positive consanguinity are more likely to develop diabetes at this young age by approximately six times than schoolchildren who had negative consanguinity [Figure 1] and [Table 2].
Figure 1: Demographic data of studied schoolchildren. (a) Prevalence of diabetes by sex; (b) distribution of family history (FH) of type 1 diabetes mellitus; (c) distribution of family consanguinity.

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Table 2: Distribution of family history of type 1 diabetes mellitus and consanguinity among studied schoolchildren

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The overall prevalence of diabetes among schoolchildren was 3.75/1000. Male students were more affected than female students (66.7 vs. 33.3%). The mean age of all diabetic children was 11.3 ± 2.8 years. Their mean weight was 38.9 ± 15.0 kg, mean height was 143 ± 18.0 cm, mean BMI was 19.8 ± 2.1, and the mean of random blood sugar was 288.7 ± 60.2 mg/dl [Table 3].
Table 3: Clinical profile of diabetic children

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Moreover, the weight of studied diabetic male schoolchildren was higher than the weight of diabetic female students in the younger age group (6–10 years) but lower than diabetic female students in the older age group (10–15 years). The difference was not significant statistically among the younger age group of 6–10 years, but it was statistically significant among the older age group (>10–15 years) [Figure 2]a and [Table 4].
Figure 2: Mean values of anthropometric measurements for diabetic children distributed by different age groups and sex. a) in relation to the mean values of weight. b) mean values of heights and c) mean values of BMI

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Table 4: Anthropometric measurements for diabetic children distributed by different age groups and sex

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Diabetic male school children were higher than diabetic female students in younger age group (6–10 years) and the difference was not significant statistically, but lower than diabetic female students in older age group (10–15 years) and the difference was significant statistically [Figure 2]b and [Table 4].

In addition, diabetic female schoolchildren had a higher mean BMI than diabetic male students in both age groups, with significant difference detected among each age group [Figure 2]c and [Table 4].

Centiles for anthropometric measurements of diabetic children are given in [Table 5].
Table 5: Centiles for anthropometric measurements of diabetic children

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  Discussion Top


The prevalence of DM varies considerably among different groups in the world, and the study of these variations may help to elucidate the pathogenetic factors of the disease that may affect these groups [7].

The importance of juvenile DM as a public health problem is detected from the number of patients who suffer from the disease and the new cases acquiring it [8].

Estimation of the prevalence of juvenile DM could be used to study its varied etiology, and the effect of inheritance and environment in its genesis. In addition, the prevalence rates are essential for planning organization of national medical care for diabetes [7].

In our study, we tried to find out the prevalence rate of juvenile DM among schoolchildren in Menoufia governorate. The study was carried out in 10 schools. The total number of children was 8000. Their ages ranged between 6 and 15 years. They represented different socioeconomic strata of Menoufia. In our study, 30 children were found to have juvenile-onset DM. Therefore, a prevalence rate for 3.75/1000 was detected.

A recent study of the incidence and prevalence of T1DM in children and adolescents in three Egyptian governorates (El-Fayoum, North Sinai, and Suez) showed a prevalence rate of 0.7/1000 and an incidence rate of 4.01/100 000 [5].

Such variations in the prevalence rate from one country to another may be caused by different immunological, demographical, and nutritional variables. In addition, the facilities to examine a large sector of population and the different methods used in statistical evaluation may also affect the results [9].

In the current study, 20 (66.6%) cases were male and 10 (33.3%) were female. This denotes the dominance of male sex with respect to this prevalence.

In the study of Stipancic et al. [10], there was no difference in the incidence between the sexes. The results of other studies are not uniform. Some studies have also shown no difference in incidence between the sexes; [11]. However, others have found the incidence to be greater in boys [12], or in girls [13].

The age-specific incidence increased with age, as we have 12 cases aged 6–10 years and 18 cases aged 10–15 years in a total of 30 positive cases in this study.

In the study of Karvonen et al. [14], age-specific incidence of T12DM was calculated in 5-year age groups (0–4, 5–9, and 10–14 years). In most populations, the incidence rates increased with age and were the highest among children aged 10–14 years. The variation in incidence rates across age groups was examined using pooled population and incidence data from all centers in the linear regression model. The difference in incidence rates between the age groups was statistically significant. However, in some populations, the incidence rates were nearly the same in all three age groups.

In the USA, the overall prevalence of diabetes among school-aged children is about 1.9/1000. The frequency, however, is highly correlated with increasing age; the range is 1/1430 children at 5 years of age to 1/360 children at 16 years [14].

The residence in the current study showed 18 cases of DM among 4000 children in urban areas (4.5/1000), whereas 12 cases among 4000 children in rural areas (3/1000).

Environmental factors are important because even identical twins have only a 30–60% concordance for T1DM and because incidence rates vary in genetically similar populations under different living conditions [15].

In this study, 26 children showed positive family history of T1DM and 14 children showed positive consanguinity.

The lifelong risk of T1DM is markedly increased in close relatives of a patient with T1DM, averaging about 6% in offsprings, 5% in siblings, and 30% in identical twins (0.4% in patients with no family history of T1DM) [16].

A monozygotic twin of a patient with T1DM has a higher risk of diabetes than a dizygotic twin, and the risk in a dizygotic twin sibling is similar to that in nontwin siblings [17].

In brothers and sisters of children with T1DM, the risk of developing the diseases is clearly related to their degree of human leukocytic antigen (HLA) identity with the index case; the average risk has been estimated to be 6–8%, increasing to 16–20% in HLA identical siblings and decreasing to less than 1% in non-HLA identical siblings [18].

Although a positive family history of T1DM is a risk factor for the disease, about 90% of cases have no affected first-degree relatives [19].

The growth pattern of our diabetic children was studied and compared with the growth pattern of normal children of the same age and sex. Wide variance concerning weight, height, and BMI was observed in our diabetic children.

Although there are several reports on growth problems of diabetic children, only a few studies have focused on the sexual development and final height [20]. It is still unclear whether these parameters are influenced by the duration of diabetes and the tightness of metabolic control alone or by some other additional factors [6].

The question of whether linear growth and sexual maturation are impaired in diabetic children is still debated. Several papers have documented retarded growth and delayed puberty with T1DM even in reasonably controlled patients [21], whereas many other studies found no effect of diabetes on growth and sexual maturation [22].

Actually, in many reports, diabetic children were found to be taller at the onset of the disease compared with nondiabetic children and attained a final height greater than the predicted genetic target height [23].

So, based on the previous studies, we conclude that juvenile DM has some effect on the growth pattern of children, yet there is still a debate on good nutrition and control of the disease can afford normal growth, to be attributed to the present state of deranged metabolism of fats and proteins among diabetics.

Health education and receiving medical information about DM were significant factors that reduce complications of DM.


  Conclusion Top


The prevalence rate of juvenile DM among school-age children in Menoufia governorate was 3.75/1000. It was more prevalent in urban areas (4.5/1000) than in rural areas (3/1000) and in boys (66.7%) than in girls (33.3%). Family history of T1DM and consanguinity were highly associated with the occurrence of diabetes. It was found that juvenile DM has some effect on the growth pattern of diabetic children, yet there is still a debate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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