Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors

<p>Abstract</p> <p>Background</p> <p>Despite the important implications of lipohypertrophy for diabetes control, there is a dearth of information and research about the subject in children. The aim of this study was to study the prevalence of lipohypertrophy in children with type 1 diabetes, and to evaluate the associated factors.</p> <p>Findings</p> <p>119 children coming for regular follow up in the diabetes clinic were examined for the presence of lipohypertrophy by inspection and palpation. The last 4 readings of glycated hemoglobin (HbA1c) levels and other factors that may affect lipohypertrophy were documented. RESULTS: The patient's age ranged from 2 months to 21 years with a median of 10 years (inter-quartile range = 6). Lipohypertrophy occurred in 54.9% of patients, more commonly in males (62.7%) vs. females (48.4%) (P = 0.074). Grade 1 lipohypertrophy occurred in 42.5% and grade 2 in 12.4%. Lipohypertrophy was related significantly to the dose of insulin units per kg of body weight (Odds ratio [OR] = 16.4; 95% CI, 2.2 - 124.6; P = 0.007), the duration of diabetes, [OR] = 1.16; 95% CI, 1.05 - 1.32; P = 0.004)), and the body mass index (BMI) [OR] = 1.68; 95% CI, 1.25 - 2.15; P = 0.006). The mean HbA1c levels of patients with grade 1 and grade 2 lipohypertrophy did not differ from diabetics without lipohypertrophy (F = 0.178, P = 0.837)</p> <p>Conclusions</p> <p>The presence of lipohypertrophy was significantly associated with the duration of diabetes and the body mass index. Children with lipohypertrophy needed a significantly higher dose of insulin units/kg of body weight to achieve fair control compared to children without lipohypertrophy. Further studies are needed to ascertain the clinical meaning of these findings.</p

Screening for thyroid disease among children and adolescents with type 1 diabetes mellitus

Altered thyroid hormones have been described in patients with diabetes especially those with poor glycemic control. The aim of this work was to evaluate; the presence of serum anti-thyroid peroxidase (serum anti-TPO) autoantibodies and the prevalence of autoimmune thyroid disease in children with type 1 diabetes mellitus. Patients and methods: Fifty diabetic children coming for regular follow-up in the diabetes clinic of El-Shatby University Children’s Hospital were enrolled in the study and 20 healthy children matching in age and sex were taken as control. History taking, clinical examination, measurement of HbA1c, serum anti-TPO autoantibodies and serum TSH levels were carried out. Serum T4 and T3 were measured in samples with abnormal serum TSH level. Results: Serum anti-TPO was positive in 12% of cases, and was negative in 100% of controls. Serum TSH level was abnormal in 50.0% of positive serum anti-TPO cases, in cases where serum anti-TPO was negative, 97.7% had normal serum TSH level, this difference was statistically significant P = 0.004. Good metabolic control was found in 42% of all diabetic children, 19% of them had positive serum anti-TPO, fair control was seen in 36%, only 5% of them were positive for serum anti-TPO, 22% had poor control and 9.1% were positive for serum anti-TPO, these differences had no statistical significance P = 0.550. Conclusion: Although serum TSH screening is more sensitive for detecting thyroid abnormalities in children and adolescents with type1 diabetes, the presence of positive serum anti-TPO antibodies may be an earlier marker for thyroid disease, therefore, patients with positive antibodies should be monitored for serum TSH elevation at yearly intervals

Microalbuminuria and glycated hemoglobin in children with type 1 diabetes mellitus

Diabetic nephropathy (DNP) is a microvascular complication that occurs in 20–40% of patients with type 1 diabetes (T1D). The main modifiable DNP initiation and progression factors in susceptible individuals may be sustained hyperglycemia and hypertension. The aim of the present work was to study glycemic control in children with T1D and the risk of microalbuminuria (MA) expressed as the urinary albumin/creatinine ratio (ACR). Subjects and methods: Forty children with T1D attending the diabetes clinic at the Alexandria University Children’s Hospital with a duration of diabetes of 3 years or more were included in the study and twenty apparently normal children were taken as controls. Clinical examination and blood pressure measurements were performed for all cases. Urine samples were collected within a 3–6 month period. The ACR in 2 of 3 specimens should be >30 mg/g before considering a patient to have microalbuminuria. HbA1c was measured and the mean of the last 4 readings was calculated. Results: 77.5% of patients had ACR >30 mg/g in two different samples. 88.8% of patients with poor glycemic control had MA compared to 53.8% with accepted glycemic control. The difference was more statistically significant among the adolescent age group (P = 0.001). MA was found in 77.2% of children with duration of T1D less than 5 years but the highest proportion was found when the disease duration was more than 10 years. There was no significant difference in systolic and diastolic blood pressure among diabetic children with and without MA (P = 0.556 and 0.781). Conclusion: Microalbuminuria in children with T1 DM is not limited to those with disease duration of 5 years or more and it may occur earlier. MA is significantly associated with poor glycemic control especially in adolescents. Other factors that may contribute to MA are not yet fully understood, further research is needed to clarify these factors

The association of polymorphic sites in some genes with type 1 diabetes mellitus in a sample of Egyptian children

Background: The major histocompatibility complex (MHC) genes have been implicated as the major genetic component in the predisposition to type 1 diabetes mellitus (T1DM). Other loci outside the MHC had also been reported to contribute in the susceptibility of T1DM. The aim of this study was to examine the role of some variants of polymorphic sites in some genes associated with T1DM in a sample of Egyptian children. Patients and methods: 60 patients with T1DM from the diabetes clinic at Alexandria University Children’s Hospital, and 60 healthy individuals were enrolled in this study. Genomic DNA was extracted using isopropanol precipitation method. Interleukin 18 (IL-18), interleukin 10 (IL-10), vitamin D receptor (VDR), protein tyrosine phosphatase non-receptor type 22 (PTPN22) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) were genotyped. Results: The findings obtained from logistic regression analysis suggest that the IL-18 single nucleotide polymorphisms SNP-137 G>C (rs#187238), the VDR Fok1 SNP T>A (rs#2228570) and the SNP-1123 C>G (rs#2488457) in PTPN22 gene showed a significant difference between patients and controls (P = 0.026, 0.030, and 0.003, respectively). The genotype distributions of PTPN22 SNP-1858, CTLA-4 SNP 49, IL-10 SNP-819, IL-18 SNP-607, and VDR BsmI SNP G>A did not show any significant difference. Conclusion: The IL-18 SNP-137 G>C (rs#187238), VDR SNP-Fok1 T>A (rs#2228570), and the SNP-1123 C>G (rs#2488457) in PTPN22 gene may have an effect on the occurrence of T1DM in Egyptian children. Further large-scale, population-based, case-control studies are needed