Abdominal obesity, metabolic syndrome in type 1 diabetic children and adolescents.

INTRODUCTION: The rapid rising prevalence of childhood obesity is related to the increased risk of cardiovascular morbidities. The type 1 diabetic patients are the group at special risk of macroangiopathy. The aim of the study was to estimate the prevalence of abdominal obesity in type 1 diabetic children compared to the general population, and to estimate the prevalence of metabolic syndrome diagnosed according to IDF criteria in type 1 diabetic children and adolescents. MATERIAL AND METHODS: 163 patients with type 1 diabetes mellitus (91 male) aged from 10 to 18 years were included into the study. The diabetes duration ranged from 0.5 to 15.2 years. The height, weight, waist circumference, body fat and blood pressure were measured. HbA1c and plasma lipids concentrations were examined. Body mass index, waist/height ratio (WHtR) and daily dose of insulin were calculated. Estimated glucose disposal rate (eGDR) as indicator of insulin resistance was calculated according to own formula. RESULTS: Abdominal obesity diagnosed as WHtR > 0.5 was found in 19 patients (11.7%, CI 95% 6.7-16.6). Associations between WHtR and HbA1c (r = 0.18; p = 0.027), cholesterol-HDL (r = -0.22; p = 0.004), systolic (3 = 0.37; p < 0.001) and diastolic blood pressure (beta = 0.19, p = 0.046) and Body Fat% (r = 0.59; p < 0.001) were observed. The prevalence of abdominal obesity in diabetic children was higher than in the general population (12.2 vs. 6.8%; p = 0.030). The metabolic syndrome was found in 12 individuals (7.4%, CI 95% 3.4-11.4). Patients with metabolic syndrome were older (16.6 vs. 14.7 years; p = 0.006) and their Body Fat% was higher (21 vs. 30%; p < 0.001) compared to patients not fulfilling the metabolic syndrome criteria. CONCLUSIONS: The prevalence of abdominal obesity in diabetic children is higher than in the general population. WHtR is associated with components of metabolic syndrome. Patients with metabolic syndrome are older and they are characterized by increased body fat.

Blood pressure in children and adolescents with type 1 diabetes mellitus--the influence of body mass index and fat mass.

INTRODUCTION: Prevalence of arterial hypertension and prehypertension in children and adolescents with type 1 diabetes mellitus is higher than in healthy people, even when diabetic nephropathy symptoms (microalbuminuria) in these patients are not detected. AIM OF THE STUDY: To estimate the influence of body mass and body composition on blood pressure in children and adolescents with type 1 diabetes mellitus. MATERIAL AND METHODS: In 164 patients (M-92, F-72), aged 14.8 +/- 2.4 years, with diabetes duration 6.0 +/- 4.2 years, body weight, height, casual blood pressure, and HbA1c level were measured. Body composition (fat mass - %FAT) was determined by bioimpedance analysis. Body mass index (BMI) and daily dose of insulin were calculated. RESULTS: Based on BMI value obesity was diagnosed in 8 (4.9%) and overweight in 37 (22.6%) patients. In multivariate analysis we a found positive correlation between systolic blood pressure (SBP) with BMI and %FAT and between diastolic blood pressure (DBP) with BMI and %FAT. Patients with BMI within normal range had the lowest value of SBP. DBP in patients with normal BMI value was lower than in overweight subjects. No differences of SBP and DBP between overweight and obese patients were noted. DBP value increased from the lower to the upper quartile of %FAT. No significant correlation was found between SBP and the quartile value of %FAT. CONCLUSION: There is a significant association between body mass index and body fat mass with blood pressure level in children and adolescents with type 1 diabetes mellitus.

[Permanent neonatal diabetes with known genetic background: oral drugs in treatment of childhood diabetes]. / Cukrzyca noworodkowa o znanym podlozu genetycznym: zastosowanie leków doustnych w terapii cukrzycy u dzieci.

Diabetes, which is diagnosed before 6 months of age, is patogenetically different than type 1 diabetes. This kind of diabetes also known as a neonatal diabetes is genetically determined with monogenic mode of inheritance. Most of these patients are carriers of heterozygous mutation in the KCNJ11 or ABCC8 gene. These mutations may activate the Kir6.2/SUR1 potassium channel in the beta cells and disturb insulin secretion, which in consequence leads to diabetes. This patological phenomenon is reversible if sulfonylureas are used as a first line therapy. In the current paper a systematic review of clinical aspects of sulfonylurea treatment in neonatal diabetes has been performed. This gives the further evidence that knowlegde of the patogenesis of neonatal diabetes may be easily transferred to bedside and clinical practice.