[Impact of long-term glycemic control on changes of lipid profile in children and adolescents with 1 type diabetes mellitus]. / Vplyv dlhodobej glykemickej kompenzácie na zmeny v lipidovom profile detí a adolescentov s diabetes mellitus 1. typu.

INTRODUCTION: Abnormalities in lipid metabolism contribute significantly to the increased occurrence of cardiovascular events in individuals with T1DM compared to healthy subjects. Disorder of lipid metabolism in T1DM is heavily dependent on maintaining of blood glucose values near the physiological range. DCCT study confirmed that patients with well compensated diabetes have similar lipid spectrum to the healthy subjects one. AIMS: We aimed to study relations of lipid profile parameters (cholesterol of high density HDL, cholesterol of low density LDL, total cholesterol - TC, triglycerides - TAG) to age, duration of T1DM (DD), blood glucose, HbA1c and if the blood pressure (BP), BMI corrected for age (BMIc) and daily insulin doses per kilogram (DI) in 30 patients with T1DM with good long-term glycemic compensation. We aimed also to find mathematical models of lipid profile parameters dependence of the parameters of glycemic control, age, duration of DM1T, blood pressure (systolic and diastolic BPs, BPd, respectively) BMIc and DI. RESULTS: HbA1c levels were significantly higher in diabetic patients compared to controls (p < 0.01), HDL were higher in diabetics than in controls (not significantly). LDL levels were in diabetics similar to controls. TAG was significantly lower in diabetics than in controls (p < 0.01). HDL significantly positively correlated with HbA1c (r = 0.372, p < 0.05) and negatively with BPs (r = -0.373, p < 0.05), TAG correlated with age (r = 0.546, p < 0.01), DD (r = 0.577, p < 0.001) and BPs (r = 0.407, p < 0.05). We also found a statistically appropriate mathematical models of the relationship of HDL and TAG with the parameters: age, DD, glucose, HbA1c, BP, BMIc, DI (r = 0.785, r2 = 0.616, p < 0.01, R = 0.758; r2 = 0.574, p < 0.05, respectively). CONCLUSION: The changes in HDL and TAG values in juvenile diabetics are significantly affected by particularly long-term glycemic control and insulin therapy.

Comparative study of serum/plasma glycation and lipid peroxidation of young patients with type 1 diabetes mellitus in relation to glycemic compensation and the occurrence of diabetic complications.

AIM OF THE STUDY: We tried to investigate whether the AGEs in serum and lipoperoxides (LPO) monitoring were suitable for an early prediction of diabetic complications (DC) development in diabetological practice. We wanted to find whether it is better to divide the file according to the presence of DC or in terms of glycemic compensation in this study. PATIENTS AND METHODS: 79 diabetic patients with duration of disease for at least 5 years were divided in respect to DC presence/absence and also to long-time glycemic compensation. HbA1c was measured by LPLC in fair capillary blood, s-AGEs were estimated spectrofluorimetrically and LPO iodimetrically and spectrophotometrically in serum. RESULTS: HbA1c, s-AGEs and LPO were significantly higher in the group with DC (+DC) vs. controls and also in -DC vs. controls. HbA1c and s-AGEs were significantly higher in +DC vs. patients without DC (-DC). HbA1c, s-AGEs and LPO were significantly higher in patients with poor glycemic compensation (PGC) compared to controls and HbA1c and LPO in patients with good glycemic compensation (GGC) compared to controls. HbA1c and s-AGEs were significantly higher in PGC vs. GGC. In the group of GGC we have found interesting significant correlations of HbA1c with HDL (r=0.451, p<0.05) and with LDL (r=-0.450, p<0.05). CONCLUSIONS: Our findings suggest that the monitoring of s-AGEs in poorly compensated diabetic patients and LPO in all may be very useful to recognize the risk of complications. The dividing of patient file in terms of long time glycemic compensation is more reliable for research of this issue (Tab. 3, Fig. 6, Ref. 41). Full Text in free PDF www.bmj.sk.

Monitoring of early and advanced glycation in relation to the occurrence of microvascular complications in children and adolescents with type 1 diabetes mellitus.

The authors aimed to evaluate if the monitoring of serum advanced glycation end-products (s-AGEs) could help to predict a development of diabetic complications. Clinical and biochemical parameters including fructosamine (FAM), glycated hemoglobin (HbA1c) and serum AGEs were investigated in children and adolescents with 1 type diabetes with (+DC) and without (-DC) complications. FAM levels (in mmol/l) were significantly elevated in +DC diabetic group compared to -DC one (3.043+/-0.459 vs. 2.614+/-0.430; p<0.001) or to controls (3.043+/-0.459 vs. 1.620+/-0.340; p<0.001) as well as in -DC compared to controls (2.614+/-0.430 vs. 1.620+/-0.340; p<0.001). HbA1c (in %) were significantly elevated in +DC diabetic group compared to -DC one (10.48+/-1.83 vs. 8.41+/-1.19; p<<0.001) or to controls (10.48+/-1.83 vs. 5.0+/-0.38, p<<0.001) and also in -DC compared to controls (8.41+/-1.19 vs. 5.0+/-0.38; p<0.001). Serum AGEs levels (in A. U.) were significantly higher in +DC group than in -DC (73.0+/-14.09 vs. 65.8+/-9.05; p<0.05) and in group +DC than in controls (73.0+/-14.09 vs. 60.17+/-13.78; p<0.05), whereas there was no difference between -DC and controls. FAM correlated with HbA1c in both diabetic groups (+DC: r=0.374; p<0.05; -DC: r=0.719; p<0.001), but not in controls. Serum AGEs were correlated with HbA1c (r=0.478; p=0.003) in +DC, but not in -DC or controls. Enhanced serum AGEs levels show that they could be not only an attendant phenomenon of microangiopathies, but also a predictor of their development.