Plasma amino acids in relation to metabolic control in insulin-dependent diabetic children

The influence of metabolic control (estimated by blood glucose, 3-hydroxybutyrate and glycosylated hemoglobin levels) on plasma amino acids was determined in a group of 56 insulin-dependent diabetic children. A multiple correlation analysis revealed significant positive partial correlations between most amino acids and blood glucose. Alanine, methionine, tyrosine, phenylalanine and arginine showed negative partial correlations to the 3-hydroxybutyrate level. The results are consistent with the postulate that ketone body inhibition of muscle proteolysis is one of the factors regulating substrate flows during insulin deficiency.     

The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty

The albumin excretion rate (AER) was studied in two groups of diabetic children and adolescents. Twenty-four-hour AER was studied in 75 children with diabetes for 5 years, in 49 children with diabetes for 10 years, in 55 children with diabetes for 10-20 years and in 21 age matched healthy controls. Overnight AER was studied in 129 diabetic children and adolescents with a duration of diabetes varying from 1-14 years. Diabetics exhibited a wide range of AER-values and when expressed per body surface area, diabetic children had significantly higher AER compared to controls. Log transformed AER-values were significantly correlated to age and body surface area in diabetics but not in controls. In the diabetics, log AER was also correlated to systolic and diastolic blood pressure but not to HbA1c. 20% of the diabetics had AER values exceeding the upper value for healthy controls which was 18.5 micrograms/min. 31/35 of them were older than 12 years. In both groups of diabetics, 5% had AER-values exceeding those reported to be predictive for later development of overt nephropathy, the youngest being 16 years old. When comparing diabetic children 0-12 years (i.e. before the maximal growth spurt of puberty) to those older than 12 years, at the same duration of diabetes, the latter group had significantly higher AER-values. No sex difference was found in either age group. It is concluded that after puberty diabetic patients also show evidence of incipient diabetic nephropathy. Thus, routine screening for microalbuminuria is recommended also in pediatric diabetes care after 12 years of age.     

Reduced serum proteins in diabetic children on a twice-daily insulin schedule

The concentrations of selected proteins of transport and nutrition were investigated in 27 diabetic children and 13 healthy controls by an immunodiffusion technique. The diabetic children had significantly lower mean pre-albumin (p less than 0.001), albumin (p less than 0.01) and orosomucoid levels (p less than 0.05) than the healthy controls. No correlation was observed between age or sex and the blood concentrations of the specific proteins analyzed in this series. Haptoglobin and hemopexin showed positive correlations with serum triglycerides (both p less than 0.01) and slight positive correlations with some of the variables of carbohydrate control. The reduced levels of prealbumin and albumin were not correlated to diabetic control as measured by HbA1, fasting plasma glucose or urinary glucose excretion. The non-physiological distribution site and the abnormal temporal pattern of insulin offered to diabetic children might be the reason for the protein abnormalities found in this study. This is seemingly the first time reduced serum levels of proteins have been reported in diabetic children.     

Bronchial reactivity in diabetic patients. Relationship to duration of diabetes and degree of glycemic control

Bronchial reactivity was studied via carbachol testing in 46 patients affected by type 1 diabetes mellitus and in 30 control subjects and via exercise testing in 55 diabetic patients and 60 control subjects. In all subjects, reactivity to skin allergen tests, the existence of atopic illnesses, and family history for these diseases were evaluated. Diabetic patients were less affected by asthma than control subjects, although their family history of atopy is greater. Bronchial reactivity, as expressed by the results of carbachol testing, was lower in diabetic patients than in control subjects. Furthermore, the duration of disease in diabetic patients was positively correlated with the results of carbachol testing. Reduced bronchial reactivity might be an indication of initial damage to the autonomic nervous system, which would thus appear to be both a complication and a protective factor.     

Human lymphocyte antigen DR types in relation to early clinical manifestations in diabetic children

Human lymphocyte antigen (HLA)-DR-typing was performed in 117 insulin-dependent diabetics with age at onset between 0.5 and 17 years (mean +/- SD, 9.0 +/- 3.9); 115 of 117 patients were DR3- and/or DR4-positive. DR4 was very common, seen alone or in combination with other DR types in 82.9% of the patients. Only two children were DR2-positive, but they also were DR4-positive. A comparison between DR3 and DR4 patients showed that DR4 patients manifested a seasonal variation of onset (most common onset during spring and autumn), had more severe signs and symptoms of the disease at onset, and were less likely to have a partial remission than patients with DR3. The results support the hypothesis that insulin-dependent diabetes mellitus is a genetically heterogeneous disease.     

Serum digoxin-like immunoreactive factor in children and its relation to sodium metabolism

Serum digoxin-like immunoreactive factor (DLIF), an endogenous substance that cross-reacts with anti-digoxin antibodies, was assessed (fluorescence polarization immunoassay) in children ( n = 134) aged 5-16 y, who had never been treated with cardiac glycosides. DLIF was found in 50% of serum samples at a mean concentration of 0.16 ± 0.06 ng/ml (range 0.03–0.35 ng/ml). Although the study population as a whole was apparently homogeneous with regard to serum sodium content, and none had clinical signs of sodium imbalance, children with DLIF showed significantly lower natraemia ( p = 0:0002), higher urinary concentration ( p = 0:001) and fractional excretion ( p = 0:001) of sodium, and increased systolic blood pressure ( p = 0:009) compared with children without DLIF. Inverse correlations were found between DLIF concentration and serum sodium ( p < 0:01), urine sodium content ( p < 0:001), 24-h sodium excretion ( p < 0:001), systolic ( p < 0:001) and diastolic ( p < 0:01) blood pressure. These findings suggest that sodium handling is different in children with and without DLIF, since this material seems to be released preferably in subjects who show a trend towards negative sodium balance. Such an association suggests that DLIF may be a physiologically relevant material involved in sodium homeostasis.     

Cardiac troponin I levels and its relation to echocardiographic findings in infants of diabetic mothers

ABSTRACT: BACKGROUND: Cardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms responsible for it are unknown. The aim of this study was to compare between infants of diabetic mothers (IDM) and infants of non- diabetic mothers (INDM) as regards cardiac troponin I (cTnI) levels (as a marker of cardiac dysfunction) and to examine the relationship between this marker and neonatal echocardiographic changes (cardiac structure and function). METHODS: A prospective, comparative study included eighty full term neonates during the first three days of life, during the period from April 2008 to June 2011. They were divided into 2 groups, group I: included 40 infants of diabetic mothers (IDMs)and group II: included 40 infants of non diabetic healthy mothers as a control group. RESULTS: 37.5% of the IDMs were large for gestational age and demonstrated a significantly lower blood glucose level than the control group (34.6 +/- 11.3mg/dl Vs 77.2 +/- 19.8 mg/dl respectively) , respiratory distress and cyanosis were the presenting signs in 67.5% of IDMs. Cardiac TnI on the second day of life increased significantly in infants of diabetic mothers in comparison to INDM (p < 0.006) . IDMs had a significant increase in left atrial thickness ( 11.5 +/- 1.8mm in IDM Vs 10.5 +/- 0.9mm in INDM P < 0.002*) and a significant increase in septal thickness (5.0 +/- 1.2mm in IDM Vs 4.0 +/- 0.5mm in INDM P < 0.001*). CTnI correlated positively with interventricular septum thickness (P-value = 0.002*). Cardiac TnI was significantly increased in IDMs with respiratory distress (P -value < 0.05). CONCLUSIONS: This study demonstrated a highly significant positive correlation between cTnI level on the second day of life and the left ventricular end diastolic diameter (LVED) and interventricular septum diameter (IVSD). Cardiac troponin I (cTnI) is a useful biochemical marker for monitoring myocardial injury in infants of diabetic mothers. An elevated cTnI concentration in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction.     

EEG abnormalities in diabetic children: influence of hypoglycemia and vascular complications

The effect of diabetic control upon EEG has seldom been studied. In the present investigation, a significant positive correlation between EEG abnormalities and degree of diabetic control was found, but no definite increase was noted in relation to the duration of diabetes. Eighty per cent of our patients having more than 5 severe hypoglycemic attacks showed evidence of abnormal EEG, suggesting that hypoglycemic coma or convulsions are closely related to EEG abnormalities (minor hypoglycemic episodes had no effect on the EEG). With the sensitive technique of fluorescein angiography, we demonstrated a clear correlation between incipient retinal angiopathy and EEG abnormalities. The factors that most positively relate to pathologic electrocerebral (EEG) activity in diabetic children are frequent and severe hypoglycemic attacks, comas and/or convulsions, and vascular changes in the retina.     

Circulating lipids and glycaemic control in insulin dependent diabetic children

The prevalence of dyslipidaemia in children with insulin dependent diabetes mellitus (IDDM) and its relation to glycaemic control was studied in a group of 51 diabetic children and a control population of 132 schoolchildren. The prevalence of dyslipidaemia in the fasting state was increased in the diabetic group (39%) compared with control subjects (17%). Serum cholesterol concentration alone was raised in 25% of diabetic subjects while serum cholesterol and triglycerides were raised in 14%, compared with 16% and 0.7% respectively in control subjects. Serum total cholesterol (5.1 v 4.5 mmol/l), low density lipoprotein cholesterol (3.2 v 2.6 mmol/l), non-esterified fatty acids (0.91 v 0.50 mmol/l), and triglycerides (0.94 v 0.76 mmol/l) were higher in diabetic children. Serum total cholesterol, triglycerides, and apolipoprotein (apo)B concentrations increased with worsening control, while serum high density lipoprotein cholesterol and apoA-I concentrations were unaltered. There were also positive correlations between glycated haemoglobin and total cholesterol, triglycerides, and apoB in diabetic children. Thus, abnormalities in circulating lipids are common in young subjects with IDDM but largely disappear if blood glucose concentrations are reasonably controlled.     

儿童哮喘控制测试及其临床应用价值

在过去的20年中,已有足够的科学证据表明哮喘能够得到有效的管理和控制,但是为了适应各地的不同情况,各国健康保健系统及哮喘治疗方案均存在差异.1993年,美国国立心肺血液研究与世界卫生组织(WHO)共同发表一个工作报告一哮喘管理和预防的全球战略,同期一个独立的网络及组织机构-全球哮喘防治创议组织(GINA执行委员会)相应成立,定期召开GINA工作会议,更新GINA,公布有关哮喘的最新循证医学结果,组织国际间的科研合作,自2001年起组织举办每年一次的世界哮喘日(WAD).