ABSTRACT
Background & objectives: There has been a rise in the incidence of diabetes mellitus in the younger population of India. There are limited data available on the immunological profile of youth onset diabetes mellitus (DM) especially in type 2. Therefore, this study was undertaken to evaluate the clinical and immunological profile of youth onset DM in north India. Methods: Fifty one consecutive patients of 8-35 yr of age with diabetes mellitus attending the Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, and Hormone Care and Research Center at Ghaziabad, Uttar Pradesh, India, were included in the study. All subjects were tested for glutamic acid decarboxylase (GAD), an islet cell antigen ICA512/IA2, and insulin antibodies. GAD and ICA512/IA2 were done by ELISA and insulin autoantibodies were tested by radioimmunoassay (RIA) method. These patients were also screened for hepatitis A to E, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) as trigger factors for onset of type 1 DM. Results: of the total 51 patients, 38 were men and 13 were women. The mean age and BMI of the subjects was 19.7 (±7) years and 21 (± 5) kg/m2, respectively. Twenty patients were below the age of 18 yr and their height was more than 75th percentile of Indian standards. All patients were symptomatic and 12 of these presented with ketoacidosis. only 48 per cent (n=24) were positive for GAD, 14 per cent (n=7) for ICA512/IA-2, and 28% (n=14) were positive for insulin antibody. Five of these patients had evidence of hepatitis E virus infection. None of the subjects had evidence of active CMV or EBV infection. Interpretation & conclusions: About half of the youth onset diabetes mellitus patients from north India had presence of pancreatic autoimmunity in the form of GAD, ICA512/IA2, and insulin antibodies or a combination of antibodies suggestive of having type 1 DM. Further studies need to be done on a large sample size in different parts of the country.
ABSTRACT
OBJECTIVES: Vitamin D deficiency is common at all ages, and low levels of vitamin D have been associated with high incidence of type 1 diabetes. Similar results are not consistent for type 2 diabetes. The aim of the present study was to estimate vitamin D status in newly detected youth-onset diabetes in north India. SUBJECTS AND METHODS: This was a prospective case control study at a tertiary care hospital in north India. Seventy two newly detected youth-onset diabetes subjects (age < 25 years), and 41 age- and gender-matched healthy controls were studied. In addition to basic information and management regarding their diabetes, metabolic parameters and serum 25(OH)D were measured in both the groups. RESULTS: Vitamin D deficiency was seen in 91.1% of the subjects with diabetes, and 58.5% of the healthy controls. Mean ±SD 25(OH)D was significantly low, 7.88 ± 1.20 ng/mL in subjects with diabetes against 16.64 ± 7.83 ng/mL in controls. Sixty percent of cases had severe Vitamin D deficiency compared with 8.3% in controls. Levels of vitamin D did not correlate with clinical parameters, such as gender, body mass index; or with biochemical parameters, such as serum calcium, phosphorus, alkaline phosphatase, fasting plasma glucose, and HbA1C. CONCLUSION: Vitamin D deficiency is common in people with youth-onset diabetes.
OBJETIVOS: A deficiência de vitamina D é comum em todas as idades, e baixas concentrações de vitamina D estão associadas à alta incidência de diabetes tipo 1. Entretanto, resultados similares não são consistentes para o diabetes tipo 2. O objetivo do presente estudo foi estimar a condição dos pacientes com relação à vitamina D em casos de diabetes de início na juventude recém-diagnosticada no norte da Índia. SUJEITOS E MÉTODOS: Este foi um estudo prospectivo controlado em um hospital de cuidados terciários no norte da Índia. Setenta e dois pacientes com diabetes de início na juventude recém-diagnosticada (idade < 25 anos) e 41 controles saudáveis, sem diabetes, pareados por idade e sexo, foram estudados. Além das informações básicas e controle do diabetes, parâmetros metabólicos e a 25(OH)D sérica foram avaliados em ambos os grupos. RESULTADOS: A deficiência de vitamina D foi observada em 91,1% dos pacientes com diabetes e em 58,5% dos controles saudáveis. A média ± DP de 25(OH)D foi significativamente baixa, 7,88 ± 1,20 ng/mL nos pacientes com diabetes contra 16,64 ± 7,83 ng/mL nos controles. Sessenta por cento dos pacientes com diabetes apresentaram deficiência grave de vitamina D, contra 8,3% dos controles. As concentrações de vitamina D se correlacionaram com os parâmetros clínicos, como sexo, índice de massa corporal, ou com parâmetros bioquímicos, como cálcio e fósforo séricos, fosfatase alcalina, glicemia de jejum e HbA1C. CONCLUSÃO: A deficiência de vitamina D é comum em pacientes com diabetes de início na juventude.