Plasma endothelin-1 and nitric oxide in children with insulin-dependent diabetes mellitus

Dysfunction of vascular endothelium is considered an early step in the development of diabetic complications. To assess plasma endothelin-1 [ET-1] and nitric oxide [NO] levels in children with insulin-dependent diabetes mellitus [IDDM] and their relation to the degree of metabolic control and disease duration. Plasma ET-1 and NO levels were assessed-by enzyme immunoassay-in 34 children with IDDM and compared to 17 healthy controls of matched age and sex. Diabetic patients had higher plasma ET-1 levels compared to controls [median [IQR]=5.9 [4.9-39.2] Vs 4.9 [4.4-6.1] pg/mI, P=0.02]. ET-1 levels were higher in patients with poor and moderate metabolic control when compared to those with ideal control [p=0.004 and 0.001; respectively]. ET-1 levels were positively correlated with NO levels [r=0.48, p=0.004]; HblAc level [r=0.57, P=0,001]; and disease duration [r=0.39, p=0.02]. Although, plasma NO levels in diabetic patients were not significantly different from controls [median [IQR]=24.6 [21.9-30.2] Vs 22.0 [21.0-26.5] umol/L, P 0.09]; NO levels were significantly higher in patients with poor metabolic control when compared to those with ideal control [p<0.001]. In children with IDDM, poor metabolic control and increased disease duration are associated with increased ET-1 production, which may be related to future diabetic complications. The elevated plasma NO levels in poorly controlled patients might mean a compensatory protective response towards increased ET-1 production

Bone mineral density and serum calcium hotheostasis in Egyptian children and adolescents with insulin-dependent diabetes mellitus

Although osteopenia is often reported as a complication of insulin-dependent-diabetes mellitus [IDDM], studies of bone mineral density [BMD] and serum calcium homeostasis in IDDM have yielded conflicting results. To determine BMD and serum calcium homeostasis in children and adolescents with IDDM and evaluate its relationship to metabolic control and disease duration. BMD was measured by dual-energy X-ray absorptiometry [DXA] in the lumbar spine [L2-L4] in 38 patients with IDDM [14 males, 24 females; aged 4-15 years; duration of diabetes 1.5-10 years] and their values were compared to those of 352 healthy Egyptian children and adolescents-[195 boys and 157 girls, aged 1-15 years]. In addition, glycosylated hemoglobin [HbA1c], serum calcium, phosphorus, 25 [OH] D3, and intact parathyroid hormone [iPTH] were measured in the diabetic patients and in 12 healthy controls of matched age and sex. As compared to normal BMD of Egyptian children and adolescents, nine patients [23.7%] had severe osteopenia [Z-score-2 SD or more negative] and 5 patients [13.1%] had mild osteopenia [Z-score:-1 to<-2 SD]; 24 [63.2%] patients had normal BMD. A negative correlation was found between BMD Z-score and disease duration [r-0.44, p=0,01], No relationship was found between BMD Z-score and metabolic control [HbA1c] or calcium homeostatic parameters. Diabetic patients had significantly lower iPTH compared to controls. On the other hand, serum calcium, phosphorus, and 25 [OH] D3 were not significantly different in IDDM patients compared to controls. IDDM in Egyptian children and adolescents was associated with osteopenia, which is significantly related to disease duration but not the degree of metabolic control. Calcium homeostasis was within normal in IDDM. iPTH was significantly lower in diabetic patients compared to controls. Periodic assessment of BMD in diabetic children and adolescents is mandatory

Growth hormone [GH] insulin like growth factor-1 [IGF-1] axis in children with controlled IDDM

To study the growth hormone-insulin like growth factor-1 [GH- IGF-I] axis in children with IDDM who had fair to good metabolic control, 20 seven prepubertal and pubertal patients having HbA1c less than 10% were investigated in addition to 30 healthy nondiabetic subjects of matched age and sex served as a control group. All subjects were evaluated clinically with thorough anthropometric measurements. In conclusion, patients with IDDM with fair to good metabolic control showed normal growth parameters and normal GH-IGF-I axis with heightened GH release in response to stress

Insulin resistance and atherogenic lipid disorders in children and adolescents with obesity

To study insulin resistance and atherogenic lipid disorders in obese children and adolescents, 35 obese subjects [more than 120% of ideal weight for height; had been investigated [20 males and 15 females] with their ages ranged from 6.5 to 14 years [11.1 +/- 2.2] along with 11 non -obese subjects of matched age and sex. All subjects were evaluated clinically with thorough anthropometric measurements. Basal blood samples after overnight fast were taken for determination of insulin [Radio immano - assay], blood glucose, cholesterol low density lipoprotein cholesterol [LDL-c], high density liporotein cholesterol [HDL-c], triglycerides [TG]. Apo-a and Apo-b. Oral glucose tolerance test [OGTT] was done with insulin determination at 0, 60 and 120 minute of OGTT. Insulin resistance index [IRI] and atheromatous index were calculated. Our results revealed: [1] Basal insulin levels, summation of insulin values during OCTT and IRI demonstrated a significantly higher values in obese compared to non-obese. [2] IRI showed positive correlation with weight% to ideal [i.e. degree of obesity], however, obesity for more than 2 years demonstrated non-significant difference compared to obesity for less than 2 years as regard IRI. [3] Lipgram in. studied obese group demortstrated significant higher values of TG and Apo-a compared to non-obese. A significant positive correlation was found between levels of TG and Apo-a and weight% to ideal Obesity for more than 2 years demonstrated a significantly higher cholesterol, LDL-c values and atheromatous index compared to obese subjects for less than 2 years and controls. [4] There was no significant correlation between insulin resistance measures and 1Liprogram. [5] Weight% to ideal showed better correlation with blood pressure, basal insulin, IRTG, to and Apo-a compared to body mass index [BMI] and waist / hip ratio. In conclusion obesity is associated with insulin resistance which is affected by the degree of obesity but not its duration. Abnormal lipid profile found in obese is affected by both the degree and the duration of obesity. Weight% to ideal is the best measure for obesity

Serum soluble interleukin-2 receptors in patients with acute post streptococcal glomerulonephritis

Serum soluble interleukin-2 receptor [SIL-2R] concentrations were determined in 14 children with acute post streptococcal glomerulonephritis [APSGN] and 10 healthy children of matched age and sex, utilizing ELISA method. The results showed that serum SIL-2R concentration in APSGN cases were significantly higher than in healthy controls and tend to decrease after clinical and urinary improvement. It was found that SIL-2 were negatively correlated with systolic blood pressure and ESR. Moreover, a significant positive correlation between SIL-2 and creatinine clearance was found. These findings suggested that serum SIL-2R can serve as an indicator of activity of APSGN and higher values associated with less morbidity