Infections in children with diabetes mellitus

Vidya Krishna, - (2007) Infections in children with diabetes mellitus. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Diabetes mellitus comprises of a group of common metabolic disorders that share the phenotype of hyperglycemia. It is the most common endocrine – metabolic disorder affecting both children and adults. The worldwide prevalence of type 1 and type 2 diabetes mellitus is increasing worldwide, with especially type 2 diabetes mellitus rising more rapidly both in children and adults due to the recent epidemic of obesity and also due to lifestyle changes. In 2000, the prevalence of diabetes mellitus was estimated to be 0.19% in people <20years and 8.6% in people >20 years. Type 1 diabetes mellitus, the most common form of diabetes mellitus encountered in childhood, accounts for approximately two thirds of all cases of diabetes mellitus in children. Incidence of the disease varies from as high as 50 per 100,000 population in European countries like Finland to as low as 0.1 per 100,000 population in Asian countries like India. The incidence of the disease is increasing especially in countries with a previous low incidence of autoimmune diseases. It is predicted that the overall incidence of type 1 diabetes will be 40% higher in 2010 than in 1997. OBJECTIVES: 1) To identify the incidence of infections in children with Type 1 Diabetes Mellitus. 2) To determine the type and severity of infections. 3) To evaluate the risk factors causing infections in diabetic children. 4) To evaluate the role of infections in precipitating diabetic ketoacidosis in diabetic children. STUDY METHODOLOGY: Study Design: This study was carried out with a Cohort study design. Setting: The study was conducted at the Institute of Child Health and Hospital for Children, Madras Medical College, a Tertiary care Children’s Hospital in Chennai. Study Period: It was done during the period of January 2005 – September 2006. Study Population: Children with Diabetes Mellitus attending the Diabetic clinic at the Institute of Child Health and Hospital for Children, Chennai (GROUP 1) were enrolled and an equal number of age and sex matched children without Diabetes mellitus enrolled from the School Health Cell and Immunisation OPD of the Institute of Child Health and Hospital for Children, Chennai as the comparison group (GROUP 2). Inclusion Criteria: For Group 1: Children with Diabetes Mellitus in the age group of 0 – 12 years and registered at the Diabetic clinic at Institute of Child Health and Hospital for Children and on regular follow up and willing to participate in the study. For Group 2: Age and Sex matched children free of Diabetes Mellitus and willing to participate in the study. Exclusion criteria: • Children with severe PEM (Grade III and Grade IV PEM) • Children with malignancies like leukaemia, lymphoma • Children on immunosuppressive drugs or steroids for any reason. • Children with Renal failure, nephrotic syndrome or any known immunodeficiency states, sickle cell anaemia and recurrent wheeze. Sample size: There is no data on infections in diabetic children, especially in comparison with normal children. Hence, the sample size was calculated for an expected 20% difference in incidence of infections between the two groups and found to be 112 in each group. RESULTS: A total of 112 diabetic children were enrolled in the study. The same number of age and sex matched children who were not the siblings of the study children were identified from the Immunisation OPD and School Health Cell of The Institute of Child Health and Hospital for Children, Chennai were enrolled as the comparison group. Both the groups of children were followed up for a period of one year from the time of enrolment. They were reviewed every month for the presence of infections and the details were documented. The data was analysed using SPSS software Version 11.0 for Windows. CONCLUSIONS: • Infections occur more frequently in diabetic patients and with more severity. • Diabetic children are more prone to infections of the skin and urinary tract when compared to normal children. • None of the diabetic children in our study suffered from tuberculosis. • None of the diabetic children in our study had Hepatitis B Virus infection. • Poor glycemic control predisposes to infections in diabetic children, especially of the skin and soft tissues. • There is no correlation between infections and diabetic ketoacidosis or its severity in children with diabetes. Maintaining good glycemic control could prevent infections in children with diabetes mellitus. Hence, there is an urgent need to create awareness in children with diabetes and their parents regarding maintenance of good glycemic control.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Infections ; children ; diabetes mellitus.
Subjects: MEDICAL > Paediatrics
Depositing User: Subramani R
Date Deposited: 11 Jun 2018 01:04
Last Modified: 11 Jun 2018 01:04

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