الفهرس 
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Abstract
Aims of the current study to describe the epidemiological features of type 1 diabetes mellitus in the from of sex, residence , age group at diagnosis ,maternal occupation , the pattern of seasonality at birth and at diagnosis , birth order , type of feedig type of delivery , parents consanguinity , maternal occupation , family history of diabetes mellitus the precipitating factors the initial symptoms of presentation and insulin regimen among children.Diabetes mellitus (DM) is a group of metabolic diseases characterized by
chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or
both (ISPAD consensus guidelines, 2007).
Two main categories with various subtypes currently identified are type 1
DM and type 2 DM. Type 1 DM occurs in less than 10 % of people diagnosed with
diabetes (McCarthy et al, 2001). Type 1 DM is the most common metabolic
disease in childhood (Ross et al, 2003).
Type 1 diabetes (T1D) is an autoimmune disorder that likely results from a T
cell mediated autoimmune process targeted at the β-cells in the pancreas. It is one
of the most common pediatric diseases and viewed as a complex disease with
varied pathogenesis, clinical appearance and outcome (Mayer-Davis et al, 2009).
Type 1 diabetes is often called insulin dependent diabetes mellitus (IDDM) due to
the lifelong clinical need of exogenous insulin to sustain life (Mordes et al, 2004).
There is a clear seasonal variation in diagnosis of diabetes, and children may
have a preceding, precipitating factor like infection. However, seasonal factors
could influence not only precipitating mechanisms just before diagnosis, but also
initiating or promoting mechanisms very early in the disease process (Moony et al,
2004). Also, seasonal variation in nutrition or infections might influence pregnant
mothers and their fetuses, or the baby during its early life. Some studies haveconfirmed the relation between month of birth and the risk of developing diabetes
(Rothwell et al, 1996). An Egyptian study showed that age, seasonal variations,
viral infections, emotional stress, high birth order and consanguinity between the
parents and family history of diabetes were risk factors for development of Type 1
DM (Salem et al, 1990).
Diabetes prevalence in some Eastern Mediterranean countries is among the
highest in the world. The highest rates are reported in Egypt, Kuwait, Lebanon,Oman and Qatar where the incidence of type 1 diabetes is reported to be 8-10 per
100 000 population per year in children aged <15 years (WHO. Guidelines for the
prevention, management and care of diabetes mellitus 2006).
Incidence rate varies greatly between different countries, within countries,
and between different ethnic populations. The incidence of Type 1 DM increased
worldwide in the closing decades of the 20th century. Steep rises in the age group
under 5 years has been recorded recently (Gale et al, 2002). The incidence of type
1 diabetes is increasing and this may double the burden of disease in our youngest
by 2020. The recent increase in incidence is mostly happening in the very young
and those with moderate genetic susceptibility. Many environmental factors have
been implicated, but no major determinants have been clearly identified, and the
mechanisms of involvement remain elusive. This review summarizes current
research efforts directed at understanding the possible reasons for this increase,
including the role of viruses, gut micro biota, early life feeding patterns, perinatal
factors and childhood growth patterns. It also provides a road map for future
research directions (John Wiley et al, 2010)Recent epidemiological studies have focused on determining what triggers
the body to destroy pancreatic β-cells, which produce insulin. Studies have
suggested multiple risk factors, including genetic predisposition, diet, body size,
seasonality of birth, viruses and geography, in addition to autoimmunity
(Lernmark et al, 2008). The rising incidence of T1D over the past decade is too
rapid to be completely attributed to an increase in genetic susceptibility. Recent
reports from Australia, Europe and the United States have shown that the
proportion of youth with T1D having the highest risk human leukocyte antigen
(HLA) genotype (DR3/4) has not changed over time; rather the majority of
individuals with new onset T1D are those with the moderate risk HLA genotypes
(DR3/3 and DR4/4) (Vehik et al, 2008)Type 1 DM is a disease with both acute and chronic complications that are
associated with serious illness and shortened life. It has been estimated that
average life span of individuals with diabetes is about 10 years shorter than nondiabetic
general population (Alemzadeh et al, 2004). The aim of management is
control of hyperglycemia, general health maintenance, psychological and
emotional satisfaction, and prevention of acute and chronic complications. The
aspects of management include insulin therapy, nutritional management, exercise,
educational aspects, and psychological aspects (Devendra et al, 2004This study aimed to describe the epidemiological features of type 1 diabetes
mellitus in the form of (sex, residence, age group at diagnosis, maternal
occupation, the pattern of seasonality at birth and at diagnosis, birth order, type of
feeding, type of delivery, parents’ consanguinity, maternal occupation, family
history of diabetes mellitus, the precipitating factors the initial symptoms of
presentation and insulin regimen) among children.