ABSTRACT
INTRODUCTION: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children that may be complicated by micro or macrovascular complications. Measurement of the carotid intima-media thickness (CIMT) allows the early detection of atherosclerotic alterations of blood vessels that may complicate T1DM. SUBJECTS AND METHODS: This study is a case-control study. Participants were classified into two groups. The first group included 40 children with T1DM and the second group included 30 matched healthy controls. The studied cases were recruited from Endocrinology and Diabetology Unit, Pediatric Hospital, Ain Shams University. Serum apelin, cholesterol, TG, LDL were measured for every case. Also, albumin level was analyzed in urine. Measurement of the carotid intima-media thickness (CIMT) was done for all cases. RESULTS: Comparison between T1DM patients and controls revealed that serum apelin, cholesterol, TG, LDL and albuminuria were significantly increased in cases compared to controls. Significant positive correlations were detected between HbA1C, albuminuria and lipid profile with apelin in the diabetic group (p < 0.05). CIMT has significant positive correlation with serum apelin levels (r = 0.36, p = 0.05). Also, this study found positive correlations between CIMT and some variables as LDL, SBP z-score and duration of the illness. CONCLUSION: Increased levels of serum apelin in T1DM patients may be considered as predicting factor for the ongoing development of vascular sequels. This study highlighted the possible validity of apelin assay as an early predictor of atherosclerosis in T1DM children. Evaluating CIMT in these patients is of at most important for early detection of subclinical atherosclerosis.
ABSTRACT
UNLABELLED: Type 1 diabetes mellitus is the most common metabolic disease in childhood. An interplay between genetic susceptibility and environmental factors (triggering or suppressive) may account for the pathogenesis of type 1 diabetes The diabetes control and complications trial (DCCT) showed the importance of strict metabolic control in delaying and preventing complications. The aim of this work was to describe the epidemiological features of type 1 diabetes mellitus (the pattern of seasonality at birth and at diagnosis, the initial symptoms of presentation, and the precipitating factors) and to compare the frequency of occurrence of long term complications (as microalbuminuria, and diabetic neuropathy and retinopathy) in relation to different insulin regimens among children attending pediatric hospital at Ain Shams University. This descriptive study was conducted on 416 patients of type 1 diabetes mellitus at pediatrics hospital, Ain Shams University. For each patient a questionnaire form was filled in through an interview with the patients and/or their parents and clinical examination was performed. Also, data were collected retrospectively from the patients' medical records. There was evidence of seasonality at diagnosis with overall predominance at summer. Also, seasonality at birth was clearly evident where 48.3% of cases were delivered during summer season. Polyuria and polydepsia were the most common presenting symptoms, 90.14% and 80.04% respectively. About 60.57% of cases were presented by Diabetic Ketoacidosis (DKA). As regards the precipitating factors, infection preceded the diagnosis of 21.9% of cases, while psychological trauma was evident in 8.7% of cases. Frequencies of occurrence of long term complications were 9.6% for microalbuminuria, 2.4% for hypertension, 1.4% for orthostatic hypotension, 4.1% for diabetic retinopathy, and 3.1% for diabetic neuropathy. These complications were more frequent with conventional insulin regimen in comparison to the intensive regimen and the difference was statistically significant. CONCLUSIONS: Seasonal pattern was evident at diagnosis and at birth which is more common during summer. Diabetic children on intensive insulin therapy were experienced less long term complications than those on conventional regimen. RECOMMENDATIONS: Longitudinal studies are required to confirm the presence of seasonality at birth and at diagnosis including control from normal population .Intensive diabetes therapy should be encouraged among children with type 1 diabetes mellitus to delay onset of long term complications.
