Clinique et diagnostic du diabète de l'enfant

Abstract

Childhood diabetes mellitus is mostly insulin-dependent and caused by autoimmune destruction of the pancreatic islet β-cells (type 1 diabetes). The annual incidence is increasing in France, reaching now 10 new cases/100 000 children between 0 and 15 years of age. Approximately 75 % of diabetes are diagnosed on polyuria, polydipsia, polyphagia, and weight loss. Ketoacidosis occurs in 25 % of newly diagnosed diabetes. Diagnostic criteria for diabetes mellitus include symptoms of diabetes associated with a random plasma glucose > 200 mg/dl. Bêta-cell autoantibodies (ICA, anti-GAD, anti-insulin and anti-IA2) are present in at least 90 % of children with newly diagnosed diabetes. Ketoacidosis in subjects with established diabetes often results from a deliberate cessation of insulin treatment in adolescents. The manifestations are tachypnea and abdominal pain. The major life-threatening complications of ketoacidosis are hypokaliemia, pulmonary aspiration, and cerebral edema, with 1-2 % mortality. Hypoglycemia is defined by plasma glucose less than 60 mg/dl. The clinical manifestations correspond to the adrenergic response (minor hypoglycemia), followed by neuroglycopenia (severe hypoglycemia). Hypoglycemia unawareness occurs in most of the patients with type 1 diabetes after > 5 years of diabetes duration, increasing the risk of severe hypoglycemia. Diagnosis of diabetic microvascular complications is based on annual microalbuminuria measurement and fundus examination in diabetic adolescents with at least 5 years of diabetes duration. Diabetes prediction in first-degree relatives of diabetic patients relies on the detection of multiple diabetes-associated autoantibodies. Rare forms of childhood non-autoimmune diabetes include neonatal diabetes, MODY (maturity-onset diabetes of the young), Wolfram syndrome, mitochondrial diabetes and type 2 diabetes….