Angiotensin-converting enzyme gene polymorphism and lipid profiles in Kuwaiti children with type 1 diabetes

METHODS: We studied angiotensin-converting enzyme (ACE) gene polymorphism and lipid profiles in Kuwaiti children with uncomplicated type 1 diabetes. A total of 125 children with type 1 diabetes were matched in a case-control study on age and gender to 125 non-diabetic children as controls. Serum lipids (total cholesterol, TC; high-density lipoprotein cholesterol, HDL; low-density lipoprotein cholesterol, LDL-c; triglycerides, TG; apolipoprotein A1 and B, apo A1 and B; lipoprotein(a), Lp(a)); and glycated hemoglobin, HbA1c were evaluated according to ACE genotypes. RESULTS: Genotype distributions were found to be similar in cases [ACE insertion/insertion (II) 9.6%, ACE insertion/deletion (ID) 38.4%, ACE deletion/deletion (DD) 52.0%], and controls (II 8.8%, ID 43.2%, DD 48.0%), and were characterized by higher frequencies of DD, ID, and lower frequencies of II. Diabetic children with DD genotype showed significantly higher levels of TC (p < 0.01), HDL (p < 0.001), and apo A1 (p < 0.001) than controls. There was a higher proportion of diabetic children with family history of cardiovascular disease (CVD) in the DD genotype group (51.9%) than those with II genotype group (11.1%) (p < 0.001). Also, there was a significant increase in the frequency of diabetic children with Lp(a) > 30 mg/dL in children with a family history of CVD (p = 0.008). Lp(a) levels were correlated with HbA1c in the diabetic group (r = 0.239, p = 0.019), but when patients with poor glycemic control (HbA1c > 9%) were excluded, the significant correlation disappeared (r = 0.127, p = 0.381). After adjusting confounding between variables, the logistic regression analysis showed that the two significantly related variables with the rise in Lp(a) were increasing TC level and poor glycemic control. CONCLUSIONS: In children with type 1 diabetes, the role of ACE polymorphism as a probable contributor to CVD seems to be partially mediated through other factors such as poor glycemic control, TC, and Lp(a) level. A longitudinal study is recommended with a larger number of patients in each ACE genotype group in order to assess such associations.     

Normal stimulated growth hormone secretion but low peripheral levels of insulin-like growth factor I in prepubertal children with insulin-dependent diabetes mellitus

The hypothalamo-pituitary-insulin-like growth factor I (IGF-I) axis was studied in 24 prepubertal children with insulin-dependent diabetes mellitus (IDDM) and 12 non-diabetic children. There were no significant differences between the diabetic and control subjects in basal concentrations of immunoreactive growth hormone releasing hormone (ir-GHRH), growth hormone (GH) or stimulated GH levels, but after exercise ir-GHRH concentrations were higher in the diabetic children. Peripheral IGF-I levels were significantly lower in the diabetic children, and even lower in those with poor metabolic control. A positive correlation was found between IGF-I levels and circulating free insulin concentrations in the diabetic subjects (r = 0.49, p < 0.05). These observations suggest that the GH response to physiological stimulation is normal in prepubertal diabetic children. Exercise-induced GH response may not be mediated by GHRH. IGF-I levels were reduced in prepubertal children with IDDM and even more so in subjects with poor metabolic control. This may be a consequence of transitory hypoinsulineamia, emphasizing the importance of adequate insulinization to facilitate optimal growth in children and adolescents with IDDM.     

Serum lipoprotein (a) in type 1 diabetic children and adolescents: Relationships with HbA1c and subclinical complications

In a population of 106 young type I diabetic patients, we evaluated whether a relationship exists between lipoprotein (Lp)(a) or apolipoproteins and the degree of metabolic control (HbA1c, fructosamine) or the subclinical complications. The patients were subdivided according to puberty and to the presence or not of subclinical complications (no complications [n= 32]; retinopathy at fluorescein angiography [n=28]; neuropathy diagnosed by reduced peroneal motor nerve conduction velocity [n=30]; nephropathy determined by presence of micro-albuminuria [n=15]). Lp(a) concentrations were not significantly increased in the whole group of diabetic patients. There was no difference between girls and boys, nor between the prepubertal children and the others. There were no significant correlations between the markers of metabolic control and Lp(a). Nevertheless, if the diabetic patients were divided into two groups according to the levels of HbA1c (<7.6 or 6% Hb), Lp(a) tends to be higher in the poorly controlled, but not to any significant degree. On the other hand, significant increases of total cholesterol, triglycerides, low density lipoprotein cholesterol and apolipoprotein B levels were observed in poorly controlled patients. Lp(a) concentrations were significantly lower in patients with subclinical neuropathy or nephropathy than in patients without these complications, but not in patients with retinopathy versus no retinopathy. These results are confirmed by categorical analysis (i.e. Lp(a) 30 vs >30 mg/dl).Conclusion Lp(a) levels are not significantly increased in poorly controlled insulin-dependent diabetes mellitus patients. High levels of Lp(a), in young diabetic patients, are no markers for subclinical complications (retinopathy, neuropathy and nephropathy). On the contrary, low Lp(a) levels were found in subjects with subclinical neuropathy or nephropathy.     

Urinary cytokine response to asymptomatic bacteriuria in type 1 diabetic children and young adults

It has been reported that urinary interleukin-6 (IL-6) and IL-8 levels are decreased in adult diabetic women with asymptomatic bacteriuria (ASB) when compared with non-diabetic women with ASB. Such impaired cytokine excretion might play a role in the higher prevalence of ASB among diabetic subjects. The aim of this study was to examine the urinary IL profile in children and young adults with type 1 diabetes mellitus (T1DM) with and without ASB. Midstream clean voiding urine samples were collected and cultured from 133 patients with T1DM (age: 15.6 +/- 5.7 yr) and 178 controls (14.1 +/- 4.7 yr) for two consecutive days. ASB was diagnosed in the case of >or=10(5) bacteria/mL. The urinary IL-6 and IL-8 concentrations were determined, and the presence of leukocyturia was also recorded. The prevalence of ASB was 16.5% in diabetic subjects and 2.8% in controls (p = 0.001). There was no difference between the diabetic and the control groups in the prevalence of 'IL-6-uria' (21.9 vs. 18.0%; p = 0.41), but IL-8 was more frequently detectable in the diabetic group (47.4 vs. 27.5%; p = 0.001). In individuals with ASB, the IL-8 level was similar in the diabetic (median: 70.0 pg/mg creatinine) and control group (42.3 pg/mg creatinine; p = 0.8). Indeed, the IL-8 levels were higher in diabetic subjects with ASB as compared with those without it (70.0 vs. <3.1 pg/mg creatinine; p = 0.001), and there was a significant association between the urinary IL-8 concentration and the bacterial count (p = 0.001). Diabetic patients with leukocyturia had higher IL-8 concentration than those without it (20.9 vs. <3.1 pg/mg creatinine; p = 0.003). Weak significant correlation was found between urinary IL-8 and hemoglobin A1c (HbA1c) (r = 0.4; p = 0.002). The sensitivity and specificity of leukocyturia were 50 and 89.9% in the whole population and those of IL-8 were 74.1 and 67.5%, respectively. In diabetic patients, 36.4% of the bacteriuria were gram-negative and 63.6% gram-positive. Our results suggest that diabetic children with ASB mount an IL-8 response to pathogens, which is comparable to non-diabetic children with bacteriuria. Thus, early in the natural history of diabetes, there are no significant changes in the IL response of children with ASB, as previously reported in adults.     

Lipoprotein(a) levels in girls with premature adrenarche

Aim: Elevated lipoprotein(a) (Lp(a)) level is a risk factor for cardiovasculary disease (CVD). Women with polycystic ovary syndrome (PCOS) have higher Lp(a) and risk for CVD than controls. The girls with premature adrenarche (PA) were shown to share similar hormonal/metabolic properties with PCOS. We compared Lp(a) levels in PA, with healthy and PCOS girls. Methods: In total, 25 PA, 20 controls and 10 girls with PCOS were evaluated. Lp(a), lipid profiles and insulin, glucose, free testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione levels were measured. A family history about CVD was obtained. Results: The mean age of girls with PA, at time of the study, was 10.04 ± 1.53, control 9.83 ± 1.58 and PCOS was 16.58 ± 1.46 years. The median (range) of Lp(a) levels were 22.5 (3.50–99.90), 9.6 (3.33–32.40) and 21.2 (5.89–85.65) mg/dL in PA, control and PCOS groups, respectively (P > 0.05). The median Lp(a)’s were 14.5 (3.50–87.00) and 24.30 (6.20–99.90) mg/dL, in prepubertal (Tanner 1) and pubertal PA girls (Tanner 2–5), respectively (P > 0.05). The median Lp(a) of prepubertal peers was 8.7 (3.33–21.17), while that of pubertal ones was 15.4 (4.72–32.40) mg/dL (P > 0.05). There was no difference between Lp(a) levels of pre‐pubertal PA girls and their peers; however, significant difference was found in Lp(a) levels in pubertal stages of PA and healthy peers (P < 0.05). The positive family history of CVD was 60% in PA; 55% and 80% in the control and PCOS groups, respectively, with no statistical difference. Lp(a) level was correlated with DHEAS (r = 0.386, P = 0.008) and free testosterone (r = 0.337, P = 0.022) levels positively. There was no significant correlation between Lp(a) and body mass index, fasting insulin and fasting glucose/insulin ratio. Conclusions: Lipoprotein(a) levels in pubertal girls with PA differ significantly from healthy peers. However, to clarify whether the girls with PA have an additional risk for CVD with respect to Lp(a), further follow‐up studies with larger number of patients are necessary.     

Cardiovascular risk factors in children with obesity,hypertension and diabetes: lipoprotein(a) levels and body mass index correlate with family history of cardiovascular disease

The aims of the study were to compare atherosclerosis risk factors in obese, hypertensive and diabetic children with positive and negative family history (FH) of cardiovascular disease (CVD) and to find which of the new atherosclerosis risk factors may be of clinical value in predicting future cardiovascular events. A total of 285 children and adolescents were divided into groups: obese, obese and hypertensive, hypertensive, and diabetic. Each group was further segregated into children with positive or negative FH of CVD. Positive FH groups were analysed according to FH of CVD before or after 55 years of age, and in parents and grandparents separately. We assessed lipids, body mass index (BMI) and new risk factors: lipoprotein(a) Lp(a), apolipoprotein A-I (apo A-I) and apolipoprotein B (apo B), homocysteine (Hcy), fibrinogen (FB), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1). A positive FH of CVD was found in 28% of the children and in 8.7% it was premature CVD. Children with a positive FH had higher BMI (25.4 versus 23.7 kg/m(2), P<0.05) and highest BMIs were found in those with FH of CVD <55 years (26.8 kg/m(2), P<0.05) or in parents (27.4 kg/m(2), P<0.05). Lp(a) levels were higher in children with a positive FH (0.38 versus 0.28 g/l, P<0.05) and highest in children with a FH of premature CVD (0.44 g/l, P<0.05). Differences were also found in apo B levels (0.90 versus 0.84 g/l, P<0.05). In logistic regression analysis only BMI and Lp(a) were significant in predicting future cardiovascular events. CONCLUSION: obese, hypertensive and diabetic children often originate from families with cardiovascular disease. Children with a family history of cardiovascular disease have a higher body mass index. Levels of lipoprotein(a) and apolipoprotein B may be predictive of future cardiovascular disease in predisposed children.     

The severity of clinical presentation of type 1 diabetes in children does not significantly influence the pattern of residual beta-cell function and long-term metabolic control

Aim: The purpose of the present study was to compare relationships between the clinical presentation of type 1 diabetes in children and residual β‐cell secretion and long‐term metabolic control. Methods: This retrospective study was conducted in 66 diabetic children with age at diagnosis ranging from 0.7 to 14.8 yr. The patients showed contrasting characteristics at diagnosis: either diabetic ketoacidosis (DKA) (group 1, n = 29) or absence of metabolic derangement (group 2, n = 37) associated with marked (group 2A, n = 12) or mild hyperglycemia (group 2B, n = 25). A regular follow‐up was available for at least 10 yr (10–32 yr) in all cases and for 20 yr in 23 cases. C‐peptide levels were measured from diagnosis and thereafter at intervals for the first years of disease until becoming permanently undetectable. Results: C‐peptide levels at diagnosis were undetectable in about 20% of the cases both with and without DKA. C‐peptide levels at diagnosis, the duration of measurable C‐peptide levels and the maximum value found during follow‐up were not significantly different in the three groups and were not correlated with glycated hemoglobin (GHb) calculated throughout the whole period. No differences were found between the groups of patients concerning GHb values and insulin dose at 10, 15 and 20 yr of disease. The patients of group 2A, characterized by an extremely high glycemic level without ketoacidosis, had a significantly higher prevalence of HLA DR3/4 heterozygosity. Conclusions: The severity of clinical presentation at diagnosis does not significantly influence residual β‐cell function, and long‐term metabolic control.     

1型糖尿病对儿童认知功能的影响

目的：研究1型糖尿病患儿认知功能变化,并探讨其可能的影响因素。方法：选择年龄6~16岁且病程≥1年的32例1型糖尿病患儿为研究对象,采用中国韦氏儿童智力量表对其认知功能进行研究和分析,并应用多元回归分析法探讨认知功能的影响因素。同性别、同年龄健康儿童32例作为对照组。结果：糖尿病组言语智商显著低于对照组（97±15 vs 118±13,P＜0.01）,总智商亦显著低于对照组（99±15 vs 113±12,P＜0.01）。在分测验中,糖尿病组的言语量表中的知识、分类、领悟、算术、词汇量表分低于对照组,差异均有统计学意义（P＜0.01）。多元回归分析显示糖尿病儿童的糖化血红蛋白与总智商、言语智商及操作智商呈显著负相关（分别r=-5.64、-7.29、-3.00;均P＜0.05）。结论：1型糖尿病可能对患儿言语智商产生影响,进而影响患儿总智商水平。糖化血红蛋白可能为影响糖尿病患儿认知功能的独立危险因素。     

Clinical value of glycated hemoglobin and fructosamine in the long-term glycemic control of children with acute lymphoblastic leukemia

Hyperglycemia in children with acute lymphoblastic leukemia (ALL) has been well documented in the literature. The puipose of the present study was to evaluate the clinical value of glycated hemoglobin (GHb) and fructosamine (Frc) in the long-term glycemic control of ALL patients. An attempt was made to identify the risk factors for hyperglycemia in ALL patients. The study group comprised 26 newly diagnosed ALL patients admitted to hospital during1995–96. Patients with a history of blood transfusion or infection within the past 3 months were excluded from the study. White blood cell (WBC) counts, fasting blood glucose (FBG). GHb and Frc levels were analyzed in venous blood on screening day 0, before induction of chemotherapy. Frc analysis was repeated on the 21st day and GHb level on the 60th day of chemotherapy. FBG tests were performed before each dose of L-asparaginase, on days 21 and 60. None of the patients was obese. Although six children (23%) had hyperglycemia during the induction therapy, four of them had a GHb level higher than normal on admission. Only one patient who developed hyperglycemia had a family history of diabetes mellitus. Patients with a high initial WBC count (>20× 10⁹/L) had a significantly higher baseline GHb than patients with a WBC count below this level. GHb values returned to normal after achievement of complete remission. It is suggested that the leukemic process could impair glucose metabolism and baseline GHb may be used to monitor possible small changes in glucose homeostasis of ALL patients, prior to chemotherapy.     

Low levels of vitamin D in North Indian children with newly diagnosed type 1 diabetes

Borkar VV, Devidayal, Verma S, Bhalla AK. Low levels of vitamin D in North Indian children with newly diagnosed type 1 diabetes. Background: To find out whether vitamin D levels are lower in children with newly diagnosed type 1 diabetes (T1D) as compared to non‐diabetic subjects. Methods: Plasma levels of vitamin D (25‐OHD) were measured by high performance liquid chromatography (HPLC) in 50 children aged between 6 and 12 yr within a week of diagnosis of T1D, and in 50 healthy children. Results: The mean levels of vitamin D were significantly lower in patients as compared to their controls [20.02 ± 10.63 ng/mL (50.05 ± 26.57 mmol/L) vs. 26.16 ± 12.28 ng/mL (65.4 ± 30.7 mmol/L), p‐value 0.009]. Twenty‐nine (58%) children in the study group were vitamin D deficient (25‐OHD level < 20 ng/mL or < 50 mmol/L) as compared to only 16 (32%) in the control group. Overall, 43 (86%) diabetic and 38 (76%) healthy children were either vitamin D deficient or insufficient. Conclusion: These results suggest that vitamin D levels are low at the onset of T1D, and they strongly support the need for further clinical studies to prospectively evaluate the effect of vitamin D supplementation on T1D rates in this patient population.     

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

The aim of this study was to assess the relationship between bladder dysfunction and impaired cardiovascular reflexes in diabetic children with no clinical symptoms of autonomic neuropathy. After 15 ml/kg of water intake, the time to first sensation to void, the voiding volume, the voiding time, the average and maximum urinary flows, and the time to maximum urinary flow were estimated by sonography and uroflowmetry in diabetic children with and without cardiovascular autonomic dysfunction (CAD), and in a healthy control group. The three groups of children were matched for age, weight and height. CAD was considered to be present if the results of cardiovascular tests were more than 2SD from the mean of healthy controls. Diabetic children with and without CAD had increased time to first sensation to void, voiding volume, and average urinary flow when compared with healthy children. Voiding volume and average and maximum urinary flows were higher in diabetic children with CAD than in those without CAD. Diabetic children with CAD had also a higher maximum urinary flow than diabetic children without CAD and healthy children. Diabetic children with CAD had a longer diabetes duration and a higher mean fructosamine level during the preceding 3 years than those without CAD. These findings suggest that diabetic children may have diminished sensation of bladder filling independent of impaired cardiovascular reflexes, however, the degree of bladder dysfunction parallels with CAD, both depending on diabetes duration and long-term glycaemic control.Presented in part at the First Meeting of Diabetic Neuropathy Study Group of the EASD, Cork/Ireland, 9–10 September, 1991     

Advanced glycation end products in children and adolescents with diabetes: relation to glycemic control and early microvascular complications

OBJECTIVE: The measurement of serum advanced glycation end products (S-AGEs) in children, adolescents, and young adults with diabetes to determine whether increased S-AGE levels may be associated with long-term glycemic control and early microvascular complications. Study design: The study was performed in (1) 178 children and adolescents with type 1 diabetes mellitus (age range, 2 to 21 years, onset before the age of 12 years; duration longer than 2 years) without clinical and laboratory signs of microvascular complications, (2) 39 adolescents and young adults (age range, 16.1 to 28.8 years) with background or preproliferative retinopathy or persistent microalbuminuria, and (3) 98 healthy age- and sex-matched control subjects. RESULTS: S-AGEs were significantly increased in preschool and prepubertal children with diabetes and were particularly elevated in pubertal subjects with diabetes compared with control subjects. S-AGEs were markedly increased in adolescents with early microvascular complications compared with both control subjects and diabetic patients without retinopathy or nephropathy. No correlation was found between S-AGEs and albumin excretion rate or blood pressure values. Glycated hemoglobulin values and S-AGEs were significantly correlated (r = 0.32; P <.01). In children with poorly controlled diabetes (HbA1 c >10%), long-term (2 years) improvement of glycemic control resulted in a significant reduction of S-AGE levels in preschool and prepubertal children, as well as in pubertal individuals. CONCLUSIONS: S-AGE concentrations may be elevated even in preschool and prepubertal children with diabetes; this means that the risk of microvascular complications may be present at an early age. Improvement in glycemic control may be associated with a significant decrease in S-AGEs.     

Serum homocysteine and lipoprotein (a) concentrations in hypercholesterolemic and normocholesterolemic children

The relationship between lipids, lipoproteins, total homocysteine, and lipoprotein (a) was studied in hypercholesterolemic and normocholesterolemic children. In hypercholesterolemic children, concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglycerides were significantly higher compared to levels in controls, whereas concentrations of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were lower compared to those in the control group. Total serum homocysteine concentrations in children with a positive family history for cardiovascular disease CHD(+) (7.28 micromol/L) were significantly higher than those in the control group (5.45 micromol/L), and in the group of CHD(-) children (5.25 micromol/L). The median value of lipoprotein (a) in patients was 31.5 mg/dL (range, 11-209 mg/dL) and in the control group, 19 mg/dL (range, 11-95 mg/dL). Concentrations of Lp (a), exceeding 30 mg/dL, were present in 45% of CHD(+) children, in 29% of CHD(-) children, and in only 11% of the control group.     

Lipoprotein(a) and cardiovascular risk factors in a cohort of 6-year-old children. The Rivas-Vaciamadrid Study

We have studied the distribution of lipoprotein(a) (Lp(a)) and its relation to lipid profiles and a family history of cardiovascular disease in grandparents in a cohort of 673 6-year-old Spanish children. Lp(a) levels were highly skewed, showed no differences between sexes and had no relevant relations with anthropometric variables. When compared with children without a family history of stroke, children with a family history of this disorder showed significantly higher levels of Lp(a) (median 13 mg/dl, range 2–110 mg/dl versus 9 mg/dl, range 2–120 mg/dl, P =0.02). Also the percentage of children with a family history of stroke was higher in the group of children with Lp(a) levels above 30 mg/dl than in the group who exhibited lower levels (20.9% versus 10.4%, P =0.002). Children with a family history of coronary heart disease had higher levels of Lp(a) than children without such history (median 14 mg/dl, range 2–120 mg/dl versus 8 mg/dl, range 2–62 mg/dl, P =0.03). Finally, when compared with children with Lp(a) levels <30 mg/dl, those with Lp(a) levels above 30 mg/dl showed significantly higher mean levels of total cholesterol (174.9 versus 169.4 mg/dl, P <0.05), low-density lipoprotein-cholesterol (109.1 versus 102.4 mg/dl, P <0.05), and apolipoprotein B (81.9 versus 74.6 mg/dl, P <0.05). Conclusion: our study shows the existence of an association between high levels of lipoprotein (a) in 6 year-old children and a family history of both cerebrovascular and coronary disease in grandparents. High levels of lipoprotein (a) were also associated with high levels of low-density lipoprotein-cholesterol and apolipoprotein B.Abbreviations Apo apolipoprotein - LDL low-density lipoprotein - Lp(a) lipoprotein(a)     

Lipoprotein(a) as a potent risk indicator for early cardiovascular disease

Aim: Elevated levels of lipoprotein (a) [Lp(a)] are associated with increased cardiovascular risk in adults. It is not known whether Lp(a) elevation can be regarded as an additional risk factor even in children and adolescents. Therefore the purpose of this study was to compare the serum concentrations, distribution and frequency of Lp(a) and lipids of children and adolescents with premature parental and/or grandparental cardiovascular disease (CVD) with controls. Methods: 103 children and adolescents, aged 6-18 y, from families with premature CVD in a parent and/or grandparent, i.e. before the age of 55 y, and 103 controls were estimated for lipids and Lp(a). Results: Mean levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and Lp(a) were significantly higher in the risk than in the control group. Median Lp(a) levels were 20 (10-61.5) mg dl 31 in the risk subjects, and 15 (6-26.5) mg dl 31 in the control subjects ( p = 0.005). Mean TC and LDL-C concentrations of the risk group compared with the control group were 211 mg dl 31 (5.5 mmol l 31 ) versus 165 mg dl 31 (4.3 mmol l 31 ) (p 3 0.0001), and 140 mg dl 31 (3.6 mmol l 31 ) versus 101 mg dl 31 (2.6 mmol l 31 ) (p 3 0.0001), respectively. Conclusion: It may be important to estimate plasma Lp(a) levels in progeny with a familial history of premature CVD, because it seems possible to identify those subjects who are at greater risk for later CVD either with or without elevated LDL-C levels.     

Intramyocellular lipid, adiposity, and muscle oxygen supply in prepubertal type 1 diabetes

Abstract:  Background: In the non-diabetic population, intramyocellular lipid (IMCL) accumulation is associated with obesity and poor muscle oxygen supply. IMCL levels are increased in type 1 diabetes, but their significance is less clear.
Methods:  We studied a group of 16 prepubertal boys (age 6.4–9.9 yr) with type 1 diabetes and a range of glycemic control [hemoglobin A1c (HbA1c) 6.4–10.2%]. Children's adiposity was assessed by anthropometry, muscle oxygen supply by near-infrared spectroscopy (NIRS), abdominal and IMCL content by magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS).
Results:  IMCL content did not associate with muscle reoxygenation rate, abdominal adiposity, duration of diabetes, or recent glycemic control. Muscle reoxygenation rate correlated with percentage body fatness (r² = 0.46, p = 0.004), visceral (r² = 0.45, p = 0.007) and abdominal subcutaneous fat volume (r² = 0.63, p = 0.0004), and dietary fat intake (r² = 0.27, p = 0.03) but not with the duration of diabetes nor HbA1c. HbA1c was significantly related to dietary fat intake only (r² = 0.28, p = 0.03).
Conclusion:  While causality cannot be inferred, interventions aimed at improving muscle oxygen supply, or preventing its deterioration, might reduce the development of adiposity in children with type 1 diabetes.     

Lipoprotein(a) in children and adolescence

Lipoprotein(a) [Lp(a)], an LDL-like lipoprotein, has an additional carrier protein - apo (a), which closely resembles plasminogen. Epidemiological and experimental studies provide overwhelming evidence that Lp(a) may promote atherogenesis and thrombosis via its LDL-like and plasminogen-like mechanisms. With more than 90% variance explainable by the apo(a) gene, Lp(a) is detectable at birth and increases with age until adolescence when the Lp(a) reaches adult levels. There is a striking close offspring-parental correlation in Lp(a) levels, which is present at birth and tracks for life. While Lp(a) levels are highly regulated genetically and difficult to change, it appears that factors during the first year of life may have more impact on Lp(a) expression profiles, which possibly have long-lasting effects. Lp(a) levels are elevated in children with obesity, diabetes, renal diseases, hypercholesterolemia and are predictive of vascular diseases in themselves and other family members. We suggest that Lp(a) should be routinely measured in both children and adults for vascular disease risk factor assessment, at least among those with high conventional Coronary Artery Disease (CAD) risk factors and those with established CAD.     

Fibronectin in children with diabetes mellitus.

Fibronectin plasma concentrations were determined in 28 children with type I diabetes mellitus and 22 healthy children. No statistically significant difference was observed between the fibronectin concentrations in diabetic and non-diabetic children. Even in children with poor glycaemic control the fibronectin concentrations (glycosylated haemoglobin greater than 10%) were not significantly higher.     

Plasma and erythrocyte vitamin E levels in children with insulin dependent diabetes mellitus.

Vitamin E is considered to be one of the most important antioxidants. There is a trend today to supply diabetic children with vitamin E in order to prevent microvascular complications. In this study, our objective was to demonstrate validity of plasma and erythrocyte vitamin E levels in diabetic children. This study was conducted on twenty-five diabetic patients aged from 7-16 years and ten non-diabetic, age-matched healthy subjects as the control group. Vitamin E levels were measured by high-performance liquid chromatography. There was no significant difference between the mean plasma vitamin E levels of diabetic and control groups, 870.80 +/- 220.51 micrograms/dl and 891 +/- 221.21 micrograms/dl, respectively (p > 0.05). The mean erythrocyte vitamin E levels of diabetic and control groups were significantly different: 183.12 +/- 62.58 micrograms/dl and 246.90 +/- 68.26 micrograms/dl, respectively (p < 0.05). Erythrocyte vitamin E levels were significantly lower than plasma vitamin E levels in both groups. We further investigated whether a correlation exists between plasma and erythrocyte vitamin E levels and duration of diabetes, insulin dose and HbA1c measurements. However no correlation was found. In conclusion, measurement of erythrocyte vitamin E levels may be considered to be more valuable than plasma vitamin E levels in diabetic children and supplementation may be provided according to erythrocyte levels rather than plasma levels.     

Sustained IL-1α, IL-4, and IL-6 elevations following correction of hyperglycemia in children with type 1 diabetes mellitus

Objective:  An imbalance of pro-/anti-inflammatory cytokines may accelerate diabetic vascular complications and interfere with proper wound healing. Currently, limited available literature suggests that plasma concentrations of certain pro- and anti-inflammatory cytokines may be altered during hyperglycemia/diabetes mellitus. It is still unclear, however, whether these concepts also apply to children with diabetes, and whether alterations in circulating cytokine levels are a permanent feature of diabetes or an acute effect of fluctuating glucose concentrations.
Methods:  Twenty-two children with type 1 diabetes mellitus (T1DM) were studied. In 13 children, postprandial morning plasma glucose was >11.1 mmol/L at least once (hyperglycemic group, or HyG group); in 9 subjects, plasma glucose never exceeded 10.6 mmol/L (non-hyperglycemic group, or non-HyG group). After admission, intensive euglycemia (5.0–6.1 mmol/L) was achieved in all participants via intravenous insulin and dextrose for at least 90 min. Blood samples were drawn every 30 min to determine plasma levels of 14 cytokines and chemokines.
Results:  Interleukin IL-1α, IL-4, and IL-6 were elevated in HyG group compared with non-HyG not only when plasma glucose was elevated but also during the first 2 h following return to euglycemia. The levels of the other 11 cytokines were not significantly different.
Conclusions:  Specific cytokines (IL-1α, IL-4, and IL-6) are acutely elevated during hyperglycemia in children with T1DM, and these elevations persist for hours after hyperglycemia has been corrected. Therefore, aside from glycemic control, additional therapeutic measures against elevated proinflammatory signals may be necessary for preventing vascular complications in children with hyperglycemic diabetes.