Vitamin D deficiency in children and adolescents with type 1 diabetes

Objective: To investigate the frequency and effects of vitamin D deficiency in children with type 1 diabetes (T1D) in a region which is known to have a high rate of vitamin D deficiency among adolescents. Methods: In this prospective cross-sectional study, 120 children and adolescents with T1D (55 girls and 65 boys) aged 3-20 years were evaluated. Serum 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), and alkaline phosphatase (ALP) levels were measured. Hemoglobin A1c levels and daily insulin requirement were also evaluated. Classification of vitamin D status was made according to the American Academy of Pediatrics (AAP)/LWEPS’s recommendations. The patients were divided into 2 groups according to their vitamin D status and also according to the season of the year in which 25(OH)D sampling was done. Results: Serum 25(OH)D levels revealed vitamin D deficiency or insufficiency in 38% of the patients. Higher PTH levels were found in the patient group whose mean 25(OH)D level was <20 ng/mL as compared to the group whose mean 25(OH)D level was >20 ng/mL (p<0.05). Only 11% of patients had secondary hyperparathyroidism. The 25(OH)D levels of patients whose serum samples were taken in summer and spring months were significantly different (p<0.05). There were no significant correlationsbetween 25(OH)D level and daily insulin dose. Conclusion: Although we could not show a significant association between vitamin D deficiency and metabolic parameters, the frequency of vitamin D deficiency in T1D children is substantial. Vitamin D status should be assessed also in patients who do not have signs of rickets.Conflict of interest:None declared.     

High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children

Epidemiological studies suggest a link between vitamin D deficiency in early life and the later onset of type 1 diabetes. The aim of this matched case-control study was to find the association between vitamin D and T1DM then to study the difference in the level of vitamin D in T1DM and healthy subjects, and to determine the associated environmental risk factors in young Qatari population. The study was carried out among T1DM children and healthy subjects below 16 years at the pediatric endocrinology outpatient clinics of the Hamad General Hospital and the Primary Health care Clinics (PHCs). The survey was conducted over a period from 6 August to 25 December 2007. The subjects were Qatari nationals male and female aged below 16 years. The study is based on matching by age, gender and ethnicity of 170 cases with those of 170 controls. Face-to-face interviews were based on a questionnaire that included variables such as socio-demographic information, assessment of non-dietary covariates, assessment of dietary intake, vitamin D intake, type of feeding, clinical manifestations and laboratory investigations. Their health status was assessed by medical conditions, family history, BMI, past or present clinical manifestations, 25 (OH)D, Calcium, alkaline phosphatase, phosphorus, HbA1C, PTH, Mg and creatinine analysis. The study revealed that vitamin D deficiency was considerably higher in T1DM children (90.6%) compared to non-diabetic children (85.3%). There was a significant difference found in the mean value of vitamin D between T1DM and non-diabetic children (P = 0.009). There were statistically significant differences between type 1 diabetic and healthy subjects with respect to the occupation of parents (P < 0.001) and consanguinity rate (P < 0.047). Family history of vitamin D deficiency was considerably higher among T1DM children (35.3%) with a significant difference between diabetic and non-diabetic children (22.9) (P < 0.012). Vitamin D supplement with breast milk was very poor in diabetic children (37.4%) compared to non-diabetic children (47.7%). Majority of the studied subjects were breast-fed children (95.1% of diabetic children and 97.2% of healthy children). Multivariate logistic regression analysis revealed that fathers and mothers occupation, family history of DM, physical activity, low duration of time under sun light, breast feeding less than 6 months and low vitamin D level were considered as the main factors associated with the T1DM. In conclusion, the present study revealed that vitamin D deficiency was higher in T1DM children compared to non-diabetic. Moreover, vitamin D deficiency was common in Qatari young population. Vitamin D intake was very poor in children and it shows that supplementing infants with vitamin D might be a safe and effective strategy for reducing the risk of T1DM.     

Reproducibility of vibration perception threshold values in children and adolescents with type 1 diabetes mellitus and associated factors

AimsTo define the reproducibility of vibration perception thresholds (VPTs) and the possible associated factors, as an early index of peripheral diabetic neuropathy (PDN) in type 1 diabetes mellitus (T1DM) children and adolescents.MethodsA single examiner studied 118 T1DM subjects (aged 13.5 ± 3.4 years) and 79 controls (aged 12.0 ± 3.07 years). Glycaemic control was assessed with HbA1c levels. VPT was measured twice on upper and lower limbs, using a Biothesiometer. Concordance between the two VPT measurements was evaluated using the Cohen's Weighted Kappa statistic (Kappa = 0.41–0.60 → moderate concordance, Kappa = 0.61–0.80 → substantial concordance).ResultsT1DM children had significantly higher VPTs than controls at all sites (p = 0.001), but with lower Kappa values (0.64–0.70). VPT values increased in parallel with HbA1c (a. < 8%, b. 8–9.5%, c. > 9.5%) and T1DM duration (a. < 5 years, b.5.1–10, c. > 10 years). However, Kappa values were lower in the groups with the poorest control (HbA1c > 9.5%) (Kappa = 0.54–0.76) or the longest T1DM duration (>10 years) (Kappa = 0.49–0.71). Although VPTs increased with stature and male gender, no effect on VPT reproducibility was observed. However, obesity was associated with lower VPT values and poorer concordance.ConclusionsThese findings suggest that the reproducibility of VPTs is lower in the high-risk patients for early subclinical PDN development, who need a regular follow-up.     

Infections in children with type 1 diabetes mellitus

To identify the incidence, type, severity and risk factors of common infections in children with type 1 diabetes mellitus (DM). In this prospective observational study design, 125 children with type 1 DM (group1) and age and sex matched 125 non-diabetic children (group2) were followed up for 12 months from a tertiary care children hospital in Chennai. Infections encountered were documented in both the groups throughout the study period. Risk factors were analyzed. Among the diabetic children 46.2% had infections and the total episodes of infections were significantly high (p?=?0.006). Skin and soft tissue infections (p?=?0.03) and urinary tract infections (UTI) (p?=?0.002) were significantly higher in diabetic children and they were more prone to recurrent infections. Mean HbA1c was significantly higher among the diabetic children with skin infections. Children with type 1 DM are more prone to skin and soft tissue infections and UTI. Skin infections are more severe and these children have higher HbA1c levels.     

Vitamin D and diabetes mellitus

Better understanding of the physiological role of the vitamin-D system, in particular its potential effects on inflammatory and autoimmune conditions as well as on insulin secretion and possibly also on insulin resistance, increased the interest in its potential role in prevention and control of the diabetic condition, both type-1 and -2 diabetes. Both these conditions are associated with inflammation and type-1 diabetes also with an autoimmune pathology. Indeed, animal and human studies support the notion that adequate vitamin-D supplementation may decrease the incidence of type-1 and possibly also of type-2 diabetes mellitus and may improve the metabolic control in the diabetes state. However, the exact mechanisms by which vitamin-D and calcium supplementation exert their beneficial effects are not clear and need further investigation.     

Dual X-ray absorptiometry body composition and its associated factors in children and adolescence with type 1 diabetes mellitus in South of Iran,a case-control study

To date, limited studies have been conducted for evaluation of the body composition with the dual X-ray energy absorptiometry (DEXA) method in children with type 1 diabetes mellitus (T1DM). Also, there are lack of data about factors associated with body composition parameters in T1DM children. This case-control study was performed on T1DM children whom had referred to Diabetes Clinics of Shiraz University of Medical Sciences, 2013–2014. Weight, height, physical activity, sun exposure, insulin regimen, and the Tanner stage of children were recorded by a trained physician. Serum lipids and glycemic tests were assessed. Body composition was assessed by the DEXA Hologic system. Statistical analysis was carried out using SPSS 18.0 software. Eighty-seven T1DM children (39 male and 48 females) and 87 age- and sex-matched healthy controls with a mean age of 12.4 ± 4.2 years were enrolled in this study. Fat mass index was more in T1DM (P = 0.012), and lean mass index was more in non-diabetic children (P = 0.013). The android/gynecoid fat ratio in T1DM children was less than that of controls (P = 0.002). On multiple regression analysis, there was an independent effect of Tanner stage (P < 0.001) and FBS (P = 0.045) on total fat, an independent positive effect of age onset of T1DM (P < 0.001) on total lean mass. This study revealed an increase in the body fat index and a decrease in the lean mass index in T1DM children.     

Vitamin D deficiency, vitamin D receptor gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes

Aim

The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D).

Methods

In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed.

Results

The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (< 20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA_1c, although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P < 0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P = 0.02) and the aa genotype of ApaI (OR: 0.46; P = 0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency.

Conclusion

The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.     

Vitamin D deficiency is significantly associated with retinopathy in young Japanese type 1 diabetic patients

The aim of this study was to examine the possible association of vitamin D deficiency with diabetic retinopathy in 75 young Japanese type 1 diabetic patients. A multivariate regression analysis, duration of diabetes and vitamin D deficiency were independent determinants of diabetic retinopathy.     

Riboflavin deficiency in children with diabetes mellitus

Summary Twenty-four insulin-dependent diabetic children and 114 normal control children, all between the ages of 6 to 16 years, were investigated for riboflavin deficiency. The method used was a measurement of erythrocyte glutathione reductase activity and the results were expressed as the activity coefficient (AC). None of the children had received vitamin supplementation. The percentage of diabetic children with riboflavin deficiency was 4 fold greater than in non diabetics. Supplementation with daily oral riboflavin quickly returned all AC values to normal.     

2型糖尿病患者维生素D缺乏的调查分析

目的 调查分析2型糖尿病患者血清25羟维生素D3[25（OH）D3]的水平和缺乏程度,初步了解维生素D缺乏与糖尿病病程和糖化血红蛋白（HbA1c）的关系.方法 选择天津医科大学总医院2型糖尿病患者140例,其中男60例,女80例,年龄21～89岁,平均（58.25±13.76）岁.分析不同年龄组即＜50岁、≥50且＜70岁、≥70岁者,不同检测季节组即冬春季和夏秋季两组,不同糖尿病病程组即＜10年、≥10且＜20年、≥20年,及不同HbA1c水平组即＜7％、≥7％且＜10％、≥10％的血清25（OH）D3水平.结果 （1）140例患者血清25（OH）D3水平均明显降低[（40.07±16.12）nmol/L],维生素D严重缺乏者占13.57％,缺乏者占67.86％,充足者仅占4.29％,不同性别患者维生素D水平和缺乏程度的差异均无统计学意义（t =0.803,x2=0.189,P均＞0.05）.（2）男性≥50且＜70岁组25（OH）D3水平较＜50岁组明显降低（F=2.362,P＜0.05）;女性≥50岁的两组患者25（OH）D3水平均较＜50岁组明显降低（F =3.928,P＜0.05）,维生素D缺乏者的比例均较＜50岁组显著增多（x2=10.036,P ＜0.01）.（3）冬春季组25（OH）D3水平显著低于夏秋季组（t=-4.681,P＜0.01）,严重缺乏者和缺乏者的比例也明显增加（x2=18.202,P＜0.01）.（4）病程≥10年的两组患者25（OH）D3水平均较＜10年组明显下降（F =5.489,P＜0.05）,≥20年组严重缺乏者的比例也多于＜10年组（x2=7.284,P＜0.05）.（5）HbA1c≥7％的两组患者25（OH）D3水平均较＜7％组明显下降（F=3.963,P均＜0.01）,其严重缺乏者和缺乏者的比例也较＜7％组明显增加（x2=6.712,P＜0.05）.结论 2型糖尿病患者普遍存在维生素D缺乏,尤其是病程长和持续血糖控制不佳者,特别需加强冬季维生素D的检测和补充.     

Study on the frequency of caries and associated factors in type 1 diabetes mellitus

Subjects with diabetes mellitus (DM) are more prone to certain disturbances of oral cavity but there are controversies concerning caries. This cross-sectional study investigated the frequency of caries and associated factors, in a sample of population with or without type 1 DM, including non-diabetic (53 women, 31 men) and 30 diabetic subjects (19 women, 11 men) aged 17-28 years. Diagnosis of dental caries was based on the DMF-T index (D= decay; M= miss; F= fill; T= teeth); in addition, a plaque control record (PCR) was obtained. A preponderance of female sex was found within the groups studied but such proportions did not differ when comparing diabetic and non-diabetic groups. Mean ages were 21.0 +/- 2.2 and 19.5+/-1.8 years, respectively for subjects without and with DM (p< 0.05). Education level was higher in the non-diabetic group as well as the DMF-T index (10.5 +/-5.8 vs. 6.7+/-5.7, p< 0.01). Linear regression analysis (n= 114) showed significant associations of DMF-T with age, sucrose intake, daily frequency of tooth brushing, of dental floss use, PCR and of visits to the dentist. By ANOVA model with age as a covariate the non-diabetic condition (p= 0.047), sucrose index and PCR (r(2)= 0.820) were independently associated with the DMF-T. In the diabetic-specific model, with only the diabetic subjects included and sucrose index as a covariate, DM duration, fundus abnormality and PCR were significantly associated with the presence of caries (r(2)= 0.816). The sample of type 1 diabetic subjects suggest that they are less prone to caries than non-diabetics, despite having a higher frequency of meals, less tooth brushing and dental floss use. We speculate that DM duration may contribute to the occurrence of caries and restricted sucrose consumption to lower frequency of caries in diabetic subjects.     

Carnitine deficiency in children and adolescents with type 1 diabetes

Carnitine is essential for the lipid and carbohydrate metabolism, and proper metabolic control in type 1 diabetes has potential impact on long-term complications. The plasma total, free, and acylcarnitine levels in 47 children and adolescents with type 1 diabetes were determined by a radioisotopic assay and compared to the values of a series of anthropometric measurements and metabolic parameters, including blood glycosylated hemoglobin Alc, serum cholesterol and triglycerides, and urine microalbumin levels. Plasma values for total, free, and acylcarnitine were 30.1+/-7.26, 20.0+/-4.50, and 10.2+/-6.47 micromol/l, respectively. Acyl/free carnitine ratio was 0.544+/-0.369. Individuals with type 1 diabetes had significantly lower total and free carnitine levels and significantly higher acyl/free carnitine ratios than controls (P<.001). Plasma total and free carnitine levels were inversely correlated to the duration of diabetes (P=.036 and P=.071, respectively). No statistical relationship was documented between carnitine levels and the remaining anthropometric and metabolic variables. In conclusion, total and free carnitine levels are decreased in children and adolescents with type 1 diabetes. This reduction is time related and may have potential interactions with the long-term complications of type 1 diabetes. Larger studies are required for final conclusions to be drawn on the precise role of carnitine and the possible benefit, if any, of carnitine supplementation in diabetic patients.     

Quality of life and associated factors among Jordanian adolescents with type 1 diabetes mellitus

ObjectivesQuality of life (QoL) is a significant indicator of the outcome of the treatment in chronic diseases. The purpose of the study was to assess the QoL of Jordanian adolescents with type 1 diabetes mellitus and its associated factors.MethodsA total of 145 adolescents with type 1 diabetes mellitus were invited to participate in the study during their regular visits to outpatient clinics. The subjects were recruited from the National Center for Diabetes, Endocrine and Genetic Diseases in Amman, the capital of Jordan, and from three main hospitals in the north of Jordan between October 2007 and February 2008. A short form of the Diabetes Quality of Life for Youth (DQLQY-SF) questionnaire was used. The DQLQY-SF consists of 22 items on two subscales (disease impact and worries) with higher scale scores indicating increase frequency of problems and lower QoL.ResultsThe mean (S.D.) age of the participants was 14.1 (3.1) years and the mean (S.D.) diabetes duration was 3.7 (2.9) years. This study showed that adolescents perceived their QoL as low. The mean (S.D.) of DQLQY-SF total score was 56.4 (18.0). The mean was 36.2 (10.1) for the impact scale, 17.9 (8.9) for worries about diabetes, and 2.2 (1.2) for health perception. Multivariate analysis showed that more impact of diabetes, worries about diabetes, and worse overall QoL were associated with shorter diabetes duration, higher HbA_1c values, being a girl, and older age.ConclusionsThe QoL of Jordanian adolescents with type 1 diabetes was low. Better glycemic control may contribute to the improvement of QoL.