P-444: Type 1 diabetes in infancy: diagnostic challenges, atypical clues and acute presentations
B Salih, D Meriem, B Hadjer, S DjawidaAbstract
Introduction
Type 1 diabetes mellitus (T1DM) is increasingly diagnosed in children under 5 years. In infants, it remains rare but severe, often presenting with atypical features leading to diagnostic delay and increased risk of diabetic ketoacidosis (DKA).
Objectives
To describe the epidemiological, clinical, biological, and outcome characteristics of infantile T1DM to improve early recognition and reduce acute complications.
Methods
A retrospective descriptive study was conducted in the Pediatric Department of CHU Tlemcen including 11 infants diagnosed with insulin-dependent diabetes. Clinical, biological, therapeutic, and outcome data were analyzed.
Results
Eleven infants were included. Mean age at diagnosis was 15 months (7–23 months) with a mean diagnostic delay of 12 days. Sex ratio was 1.4. No relevant perinatal risk factors were identified; a family history of T1DM was present in 2 cases. The main presenting features were polyuria–polydipsia (8 cases), associated with general deterioration and gastrointestinal symptoms (3 cases each). Severe DKA occurred in 3 patients, with mean initial glycemia of 4 g/L and dehydration in 4 cases. One case mimicked acute intestinal intussusception. Notably, 3 infants presented with persistent diaper dermatitis resistant to treatment as an atypical initial sign. Anti-GAD antibodies were positive in 6 cases. Initial management required vasoactive support in 2 cases and insulin therapy in all patients. During follow-up, mean HbA1c was 9%, with recurrent DKA (4 cases) and hypoglycemia (2 cases). Insulin pump therapy was introduced in 3 patients.
Conclusions
Infantile T1DM is a diagnostic emergency. Atypical presentations, particularly refractory diaper dermatitis, should raise clinical suspicion. Early recognition through systematic blood glucose testing is essential to reduce morbidity and mortality associated with acute metabolic decompensation.