Hospital based prevalence survey of secondary diabetes and its related factors

Abstract

Objective To investigate the prevalence and association factors of secondary diabetes in Chinese hospitalized children. Methods A case-control design, retrospective study on pediatric patients <18 years, who were hospitalized in Beijing Children's Hospital between Jan.2002 and Dec.2010 was carried out. Diabetes was diagnosed according to the criteria of World Health Orgnization(WHO), 1999. Control cases were chosen with 1∶4 ratio and matched in the primary diseases, age, gender. The associated risk factors of secondary diabetes was investigated with logistic analysis. Results Total 33 cases (aged 7.1-16.4 years, 15 boys and 18 girls) of secondary diabetes were identified among 9657 inpatients suffering the corresponding primary diseases. The total prevalence of secondary diabetes was 0.34%, the highest was 4.17% in lymphoma leukemia, then 3.70% in acute lymphoblastic leukemia after hematopoietic stem cell transplantation, 1.67% in multiple sclerosis and less than 1.0% in systemic lupus erythematosus, dermatomyositis, acute lymphoblastic leukemia without hematopoietic stem cell transplantation, histocytosis, idiopathic thrombocytopenic purpura, nephropathy and purpuric nephritis. The prevalence of secondary diabetes was lower in boy than that in girls(0.24% vs 0.53%, χ2=4.79, P<0.05). There were 18 cases of secondary diabetes suffering hematological malignancies and 12 cases of them developed diabetes within 6 days after L-asparaginase treatment; 2 cases with chemotherapy with non-L-asparaginase-based regimens developed diabetes at day 45 and 210 respectively, and the rest 4 patients developed diabetes during days 60 to 450 after hematopoietic stem cell transplantation. Of the patients treated mainly with corticosteroid, 15 cases were identified with diabetes 2 days to 4.7 years after the treatment. None of them had typical symptoms and diabetic ketone acidosis. Logistic regression showed that age and obesity or overweight were the risk factors for secondary diabetes(the odds ratio was 1.24 and 5.08 respectively, both P<0.05). Conclusion It's indicated that the prevalence of secondary diabetes in hospitalized children was lower in China than that in western countries and differs with gender, age and various primary diseases. Secondary diabetes can be easily miss-diagnosed due to the atypical symptoms. It is necessary to monitor glucose during the whole course of the primary diseases. Key words: Diabetes mellitus; Child, hospitalized; Prevalence