ABSTRACT
Background: Type 1 diabetes mellitus [T1DM] is an autoimmune disease identified by the presence of several autoantibodies to islet and/ or /beta-cell antigens, among which is islet cell autoantibodies [ICA]. The positivity of ICA in newly diagnosed patients with T1DM, may predict the course of the disease
Objectives: The purpose of this study was to identify the ICA positive patients with newly diagnosed T1DM and to verify how the ICA positivitycould influence the course of disease during one year follow up as regard clinical improvement[frequency of diabetic ketoacidosis [DKA] and insulin dose requirement] and glycemic ocontrol[glycosylated hemoglobin[HbAlc]level]
Methods: A prospective study was conducted over a period of twoyears at Assiut University Children Hospital; including 34 newly diagnosed T1DM children; 20 females and 14 males; the mean age was 9.14 +/- 3.52 yr. Work up for the patients included complete clinical assessment, CBC, liver andkidney function tests,lipid profile, ICA andHbAlclevels at first presentation. We followed up patients for one year with assessment of episodes of DKA, HbAlclevels quarterly, and the mean of insulin doses were calculated and assessed at the end of the study
Results: Out of 34 newly diagnosed T1DM children; 22 [64.7%] wereICA positive. The mean insulin requirement at the end offollow up was significantly greater in ICA positive group [P<0.04]. Out of 34patients, 13 [38.2%] presented by DKA as a first manifestation of T1DM, whileduring the follow up period there was no significant difference [P>0.05] between both ICA positive andnegative groups. The HbA lc levels were significantly greater in ICA positive group than those with negative results throughout the follow up period [P<0.02].Atthe time of presentation 27.3% and 63.6% of ICA positive cases had total cholesterol andLDL-Cholesterol levels which were significantly greater than IC Anegative cases [P<0.03 and P<0.001] respectively
Conclusion: Follow up of newly diagnosed children with T1DM with positive ICA had poor glycemic control [greater HbAlclevel], during the course of follow up, and higher insulin requirement at the end of follow up