Type 1 diabetes mellitus in children at the prehospitalstage. The diffi culties of diagnosis
PEDIATRIC ENDOCRINOLOGY
Abstract
The total number of patients with type 1 diabetes (T1D) under the age of 18 in the
Russian Federation as of December 31, 2023, was 61,318 (208 per 100,000 child population), with an incidence
of 8,009 (28 per 100,000 child population). In most countries, including Russia, the incidence of type 1 diabetes
in childhood is increasing. Given the epidemiological indicators and social significance of this disease, as well
as the importance of timely diagnosis of diabetes in children, an analysis was conducted of the difficulties at the
prehospital stage in diagnosing type 1 diabetes onset. The aim of the study — to analyze complex cases in the
diagnosis and management of children with new-onset type 1 diabetes at the prehospital stage of emergency and
urgent medical care. Materials and methods. We analyzed 121 medical records of children with clinical and/or
laboratory-confirmed type 1 diabetes onset who were emergently hospitalized via emergency and urgent medical
care at the Clinic of St. Petersburg State Pediatric Medical University in 2022–2023. Blood glucose levels at the
time of admission and clinical manifestations of the disease were assessed. Results. The highest blood glucose
levels were found in children aged 1–3 years (27.9±2.6 mmol/L); however, glycemia levels did not correlate with
the presence of “major symptoms” of type 1 diabetes, which is attributed to the polymorphic clinical presentation.
It was revealed that the mean age of type 1 diabetes onset in children with a history of perinatal hypoxia was
earlier (6.98±0.47 years), compared to those without such history (8.98±0.5 years). Conclusions. Type 1 diabetes
in children often presents under the “masks” of acute respiratory viral infections, intestinal or genitourinary
infections, leading to delayed diagnosis and the development of ketoacidosis. Adolescents have the longest period
from first symptoms to laboratory confirmation of type 1 diabetes. Systematic training of outpatient physicians
on the clinical and diagnostic criteria of type 1 diabetes needs to be improved.
References
1. Дедов И.И., Шестакова М.В., Галстян Г.Р. Распространенность сахарного диабета 2 типа у взрослого населения России (исследование NATION). Сахарный диабет. 2016;19(2):104–112. https://doi.org/10.14341/DM2004116-17.
2. Writing Team for the DCCT/EDIC Research Group; Gubitosi-Klug R.A., Sun W., Cleary P.A. et al. Effects of Prior Intensive Insulin Therapy and Risk Factors on Patient-Reported Visual Function Outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Cohort. JAMA Ophthalmology. 2016;134(2):137–145. https://doi.org/10.1001/ jamaophthalmol.2015.4606.
3. Шайтор В.М. Скорая и неотложная медицинская помощь детям. 3-е изд., испр. и доп. М.: ГЭОТАР-Медиа; 2024. 672 с.
4. Сахарный диабет 1 типа у детей. Клинические рекомендации. Российская ассоциация эндокринологов; 2025. URL: https://diseases.medelement.com/disease/сахарный-диабет-1-типа-у-детей-кп-рф-2025/18747 (дата обращения: 03.02.2026).
5. Госпитальная педиатрия. С.В. Бельмер, Л.И. Ильенко, ред. М.: ГЭОТАР-Медиа; 2022. 1072 с.
6. Writing Group for the DCCT/EDIC Research Group; Orchard T.J., Nathan D.M., Zinman B. et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA. 2015;313(1):45–53. https://doi.org/10.1001/jama.2014.16107.
