THE EFFECT OF EXERCISE ON DIABETIC CONTROL AND HEMOGLOBIN A1 (HbA1) IN CHILDREN

Abstract. Dahl-Jørgensen, K., Meen, H. D., Hanssen, Kr. F. and Aagem, O. (Department of Paediatrics and Department of Internal Medicine, Aker Hospital and the Norwegian College of Physical Education and Sports, Oslo, Norway). Acta Paediatr Scand, Suppl. 283: 53, 1980.—14 children with juvenile diabetes mellitus (mean age 11 years, mean diabetes duration 5 years) were enrolled in a one-hour twice weekly supervised exercise program for 5 months. A group of 8 diabetic children of same age and diabetic duration served as control group. Maximum oxygen uptake was within normal range for all children. With this exercise program the maximum oxygen uptake of the training group did not change significantly compared with the control group. The physicians rating of degree of the metabolic control based on blood-glucose measurements and urinary glucose excretion did not change in any of the groups. The insulin dosage per kilo body weight remained unchanged in both groups. In the training group the HbA, values decreased during the exercise period from 15.1±2.2 (mean HbA₁%±1 S.D.) to 13.8±1.9 (2 p <0.001). In the control group the HbA₁ values did not change significantly (13.4± 1.9 to 12.9± 1.6; 2 p =0.20). In a co-study the effect of freezing and storage of hemolysates, resulting in increased levels of HbA₁, was demonstrated.     

儿童I型糖尿病青春发育前及青春期血清IGF-I和IGFBP-3水平监测

目的：研究儿童Ⅰ型糖尿病青春发育前及青春期血清胰岛素样生长因子I(IGF-I),胰岛素样生长因子结合蛋白3(IGFBP-3)水平变化,探讨生长激素 胰岛素样生长因子I(GH-IGF-I)轴与血糖控制的关系。方法：分别采用ELISA和免疫放射法测定63例Ⅰ型糖尿病患儿和47例正常对照血清IGF-I,IGFBP-3水平,用胶乳凝集法测定Ⅰ型糖尿病患儿的糖化血红蛋白(HbAIC)。结果：①青春发育前糖尿病患儿血IGF-I为(75.4±26.6) ng/ml,IGFBP-3为(2 756.1±763.8) ng/ml,与对照组［(103.9±46.5) ng/ml,(2 717.1±480.2 ng/ml)相比无统计学差异(P>0.05);但青春期糖尿病患儿血IGF-I和IGFBP-3［(178.2±65.9) ng/ml,(2 956.0±847.6) ng/ml］均低于对照组［(229.6±54.5) ng/ml,(3 393.2±748.9) ng/ml］］P<0.05。②新发病的I型糖尿病患儿胰岛素治疗后血IGF-I为(143.0±67.5) ng/ml,IGFBP-3为(2 740.0±449.8) ng/ml,较治疗前［(54.8±44.3) ng/ml, (2 233.8±336.2) ng/ml］明显升高(P<0.05)。③糖尿病组HbA IC与血IGF-I,IGFBP-3之间存在负相关关系(r=-0.32,-0.29,P<0.01或0.05)。④糖尿病组青春期HbAIC为(9.0±1.8)%,每日胰岛素用量为(0.86±0.30)U/kg,均高于青春期前［(7.8±1.8) %,(0.64±0.38) U/kg］(P<0.05)。结论：儿童Ⅰ型糖尿病血IGF-I,IGFBP-3水平较正常儿降低,尤其青春期患儿比正常同龄儿降低的程度更为显著,提示此类患者青春期存在GH IGF-I轴的严重紊乱,可能是导致这一时期血糖控制不良的重要原因。     

不同血钾水平1型糖尿病175例的临床特征

目的了解不同血钾水平儿童及青少年1型糖尿病临床特征。方法1型糖尿病患者175例根据血钾水平将其分为3组：A组血钾〈4 mmol/L,C组血钾≥5 mmol/L,B组血钾正常（4~5 mmol/L）。对3组性别、年龄、住院时间、伴发呕吐、感染、酮症酸中毒（DKA）的比例及生化指标等临床特征进行观察。分析血钾紊乱和不同临床表现之间的关系及可能原因。结果血钾异常组较易发生代谢紊乱及伴发症状。A组40例,其发生酮症酸中毒及感染比例比B组要高。A组血氯水平最高。C组36例,发生呕吐比例比B组高,其患儿年龄较A组小,C组入院时血糖水平在3组中最高。结论糖尿病发生代谢紊乱和急性并发症时,易并血钾异常,治疗方面应积极纠正血钾紊乱。     

Thyroid Disorders in Children and Adolescents with Type 1 Diabetes Mellitus in Isfahan,Iran

Objective

Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus (T1DM). Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid (AIT), thyroid dysfunction, and goiter in children and adolescents with T1DM, compared with age- and sex-matched healthy controls in Isfahan.

Methods

One hundred patients with T1DM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies (anti-TPO Ab and anti-Tg Ab) were measured.

Findings

The prevalence of subclinical hypothyroidism was high in both groups (18%). T1DM patients had lower frequency of goiter (21% vs. 38%, P=0.001), and higher prevalence of positive AIT (22% vs. 8%, P=0.001), anti-TPO Ab positivity (19.3% vs. 5.3%, P=0.000), and anti-Tg Ab (11.1% vs. 6.4%, P=0.1) in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 (CI 95%: 1.5-15.6) for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbA_1C with serum anti-TPO Ab and anti-Tg Ab concentrations in this group.

Conclusion

Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with T1DM. We suggest regular thyroid function and antibody testing in these patients.     

Comparison of fingerstick hemoglobin A1c levels assayed by DCA 2000 with the DCCT/EDIC central laboratory assay: results of a Diabetes Research in Children Network (DirecNet) Study

BACKGROUND: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) high-performance liquid chromatography (HPLC) method for measuring hemoglobin A1c (HbA1c) serves as a reference standard against which other assays are compared. The DCA 2000 + Analyzer (Bayer Inc., Tarrytown, NY, USA), which uses an immunoassay, is a very popular device for measuring HbA1c levels in pediatric diabetes practices. OBJECTIVE: To determine how HbA1c values measured with the DCA 2000 in a multisite, pediatric diabetes clinic setting compare with corresponding HbA1c values measured in the DCCT/EDIC laboratory. DESIGN/METHODS: To examine this question, the Diabetes Research in Children Network (DirecNet) used the DCA 2000 in five clinical centers to measure baseline HbA1c levels in 200 youth with type 1 diabetes mellitus (T1DM) (aged 12.5 +/- 2.8 yr) who were participating in an outpatient clinical trial. At the same visit, an additional blood sample was obtained, refrigerated, and shipped to the DCCT/EDIC central laboratory for determination of HbA1c values. RESULTS: The central laboratory HbA1c value averaged 8.0 +/- 0.9% (mean +/- SD), with a median (25th and 75th quartiles) of 7.8% (7.3 and 8.5%, respectively). The DCA 2000 HbA1c values were strongly correlated (r = 0.94, p < 0.001), but significantly higher than DCCT/EDIC central laboratory values with a mean difference of +0.2% (95% confidence interval +0.14 to 0.23%, p < 0.001). There was some variation in the differences between DCA 2000 and central laboratory values at the five clinical centers (p < 0.001) with mean differences ranging between 0.0 and 0.3%, but differences between the two methods did not vary significantly by age or gender. CONCLUSION: Measurements of HbA1c by the DCA 2000 compare favorably with the DCCT/EDIC central laboratory method, albeit with slightly higher values.     

基础加餐时胰岛素治疗儿童1型糖尿病的疗效

目的 观察应用基础加餐时胰岛素治疗儿童1型糖尿病(T1DM)的临床效果.方法 15例T1DM患儿采用传统治疗方案治疗平均16个月:双时相低精蛋白锌胰岛素30/70,2/3量早餐前30 min皮下注射,1/3量晚餐前30 min皮下注射;之后采用基础加餐时治疗方案治疗至少12个月:3餐前0～15 min门冬胰岛素皮下注射,睡前甘精胰岛素皮下注射.观察基础加餐时方案治疗后糖化血红蛋白(HbA1c)水平、胰岛素用量和低血糖发生情况.结果 15例T1DM患儿应用基础加餐时胰岛素类似物治疗后3、6、9、12个月的HbA1c与传统治疗相比降低(t=7.15、4.88、3.46、5.28,Pa<0.01),3、6、9、12个月的HbA1c相互间比较差异无统计学意义(t=2.08、1.64、1.73、1.85、1.96、1.66,Pa>0.05).胰岛素用量差异无统计学意义(t=1.56,P>0.05).传统方法治疗期间,7例发生严重低血糖,改用基础加餐时胰岛素治疗方案后,无一例发生严重低血糖.发生轻中度低血糖的次数亦显著减少(t=13.31,P<0.001).结论 应用基础加餐时胰岛素治疗儿童T1DM可使患儿获得较好的血糖控制,同时减少低血糖发生,而胰岛素用量并无增加,并可改善患儿的治疗满意度及生活质量.     

Contemporary Australian outcomes in childhood and adolescent type 1 diabetes: 10 years post the Diabetes Control and Complications Trial

The reporting of the results of the Diabetes Control and Complications Trial in 1993 has led to a major reappraisal of management practices and outcomes in type 1 diabetes in children and adolescents. A considerable body of outcome data has been generated from Australia in this post-Diabetes Control and Complications Trial era relating to incidence, metabolic control, growth, hypoglycaemia, microvascular and macrovascular complications, cognition, behaviour and quality of life. These data are important in planning future management strategies and resource allocation and as a basis for future research.     

Evidence for an Association Between Type 1 Diabetes and Premature Carotid Atherosclerosis in Childhood

Acute phase proteins have been suggested to be increased in patients with type 1 diabetes. The aim of this study was to evaluate the relationship between serum C-reactive protein (CRP) and intima-media thickness (IMT) and functions of the common carotid artery (CCA) in children and adolescents with type 1 diabetes. Serum CRP levels were measured in 65 children and adolescents with diabetes (33 girls and 32 boys; mean age, 12.7 ± 3.8 years; range, 7–18; duration of diabetes, 6.9 ± 3.6 years). Age and diabetes duration, as well as major cardiovascular risk factors including anthropometric and metabolic parameters, were matched between girls and boys. The relations of serum CRP levels to CCA structure and functions were measured by ultrasonography as IMT, cross-sectional compliance, cross-sectional distensibility, diastolic wall stress (DWS), and incremental elastic modulus (IEM). There was no significant difference for serum CRP levels between girls and boys (3.7 ± 1.3 vs 3.2 ± 0.4 mg/L; p > 0.05). CRP was positively correlated with IMT (r = 0.49, p = 0.001), IEM (r = 0.24, p = 0.05), DWS (r = 0.58, p < 0.001), and body mass index (BMI) (r = 0.28, p = 0.05). In a multivariate regression model, we included CRP and metabolic and anthropometric parameters such as duration of diabetes, HbA1c, BMI, waist:hip ratio, age, and systolic and diastolic blood pressure as independent variables in the model for CCA structure and functions. CRP emerged as an independent correlation for mean IMT (β = 0.51, p < 0.001) and DWS (β = 0.61, p < 0.001). According to our findings, CRP was associated with CCA structure and functions in children and adolescents with type 1 diabetes.     

Role of hemoglobin A1c, duration and puberty on bone mineral density in diabetic children

BACKGROUND: The aim of the present was to determine bone mineral density (BMD) in type 1 diabetic children and the roles of hemoglobin A(1c), disease duration and pubertal stage on BMD changes. METHODS: Fifty-eight patients were investigated: 16 had been newly diagnosed (Diabetes(New)) and 42 were already on follow up (Diabetes(Follow up)). BMD of the lumbar vertebrae, HbA1c(HbA1c(last)), Ca, P, Mg were measured. Mean HbA1c of the previous year (HbA1c(1year)), the whole duration of diabetes (HbA1c(whole)), and diabetic impact index (HbA1c(whole) x diabetes duration) were calculated in the Diabetes(Follow up) group. RESULTS: Mean BMD-Z score (-0.61 +/- 0.99 g/cm(2)) of the whole group was significantly lower than zero. Osteopenia was present in 14 (24.1%), and osteoporosis in three (5.2%). HbA1c(whole) was the most important determinant effecting BMD-Z (r = -0.35, P < 0.05) with the cut-off for osteopenia and osteoporosis being 9.8% and 12.1%, respectively. The cut-off of diabetes duration for osteopenia was 3.6 years and it was more predictive for osteopenia compared to HbA1c(whole). In the Diabetes(New) group, the BMD-Z score of the early pubertal group was significantly lower than those in other pubertal groups. CONCLUSION: BMD is affected in diabetic children, and HbA1c(whole) and diabetes duration are the most important determinants. Pubertal stage is another determinant of BMD, especially in newly diagnosed patients.     

Role of Counterregulatory Hormones for Glucose Metabolism in Children and Adolescents with Type 1 Diabetes

To elucidate the mechanism of insulin resistance due to insulin counterregulatory hormones (ICRHs) and evaluate ICRH secretion kinetics, ICRH concentrations were measured and correlated with blood glucose levels in 28 type 1 diabetic patients. Blood glucose was measured before bedtime. Early morning urine samples were collected the next morning before insulin injection and breakfast. Fasting blood glucose, cortisol, glucagon and HbA1c levels were measured. Growth hormone (GH), adrenaline, cortisol and C-peptide levels in morning urine samples were measured; SD scores were calculated for urine GH. The laboratory values (mean ± SD) were as follows; HbA1c of 8.1% ± 1.4%; pre-bedtime glucose of 203 ± 105 mg/dl; fasting blood glucose of 145 ± 87 mg/dl; serum cortisol of 21.6 ± 5.5 µg/dl; plasma glucagon of 98 ± 41 pg/ml; urinary GH, 27.2 ± 13.0 ng/gCr; urinary cortisol of 238 ± 197 ng/gCr; and urinary Adrenaline of 22.9 ± 21.0 ng/gCr. The mean urinary GH SD score was increased (+1.01 ± 0.70; p=0.000); the mean plasma glucagon lebel (98 ± 41 pg/ml) was not. Fasting blood glucose was positively correlated with plasma glucagon (R=0.378, p=0.0471) and negatively correlated with urinary cortisol (R=–0.476, p=0.010). Urinary adrenaline correlated positively with urinary GH (R=0.470, p=0.013) and urinary cortisol (R=0.522, p=0.004). In type 1 diabetes, GH, glucagon and cortisol hypersecretion may contribute to insulin resistance, but the mechanism remains unclear.     

CLEC16A基因与中国儿童1型糖尿病遗传易感性及临床表现的相关性

目的研究CLEC16A基因与中国儿童1型糖尿病(T1DM)易感性及临床表现的关联。方法提取131例无血缘关系的T1DM患儿(T1DM组,均符合1999年WHOT1DM的诊断标准)及121例无血缘关系的成年健康献血员(健康对照组)的外周血基因组DNA(饱和盐析法),选取CLEC16A基因17个具有单核甘酸多态性(SNPs)的位点,运用飞行质谱技术对CLEC16A基因与中国儿童T1DM遗传易感性及临床表现的相关性进行研究。结果1.在17个CLEC16ASNPs位点多态性中,只有rs12921922和rs12931878位点的等位基因的频率在T1DM组中显著增加,其他等位基因的频率分布在T1DM组与健康对照组中无统计学差异。rs12921922的等位基因为C与T,其中T等位基因的频率在T1DM组为90.8%,健康对照组为85.0%,二组比较有统计学差异(P=0.0440)。rs12931878的等位基因为A与C,其中A等位基因的频率在T1DM组为90.1%,健康对照组为84.0%,二组比较有统计学差异(P=0.0435)。2.CLEC16A易感性基因在中国T1DM患儿不同临床表现分组中的频率分布无统计学差异。结论C...     

Effect of High-Carbohydrate Diet on Lipid Metabolism in Young Type I Diabetics: Transient Changes in High-Density Lipoprotein2 and Lipoprotein Lipase

The short-term effect of a high-carbohydrate, low-fat diet on lipoprotein metabolism was evaluated in eight young patients with type I diabetes mellitus. An isocaloric exchange diet containing 60% carbohydrate and 20% fat was administered for four weeks and serum lipid, high-density lipoprotein and subfraction cholesterol, and the activity of the lipolytic enzymes in postheparin plasma were monitored. The assay methods for lipase activity and cholesterol concentration in high-density lipoprotein subfractions were described previously. There were no appreciable changes in diabetic control, serum triglyceride and total cholesterol levels. The high-density lipoprotein₂ cholesterol level decreased significantly after two weeks on the diet and returned toward baseline levels thereafter. There was a significant correlation between high-density lipoprotein₂ cholesterol level and lipoprotein lipase activity. The high carbohydrate diet did not affect the glycemic control but induced a transient decrease in high-density lipoprotein₂ cholesterol mediated by the decrease in lipoprotein lipase activity.