Prevalence of Metabolic Syndrome in Relation to Cardiovascular Biomarkers and Dietary Factors among Adolescents with Type 1 Diabetes Mellitus.

The occurrence of metabolic syndrome (MetS) significantly affects the course of diabetes mellitus (DM), resulting in deterioration of insulin sensitivity and metabolic control, as well as many cardiometabolic complications. The aim of the study was to investigate the relationships between cardiovascular biomarkers, nutritional status, dietary factors and the occurrence of MetS among 120 participants from northeast Poland (adolescents with type 1 DM and healthy peers). MetS was assessed using several criteria: nutritional status by anthropometric measurements, body composition analysis by bioelectrical impedance, and diet using a food diary and questionnaire. MetS was diagnosed in every third diabetic. Compared to healthy peers, MetS patients had higher total body fat (26% vs. 14%, p < 0.001) and visceral fat (77 cm2 vs. 35 cm2, p < 0.001), and lower total antioxidant status (1.249 mmol/L vs. 1.579 mmol/L, p < 0.001). Additionally, their diet was rich in saturated fatty acids, but low in dietary fiber as well as mono- and polyunsaturated fatty acids. The group of diabetics reported many inappropriate eating behaviors. The combination of those with the presence of an excessive content of visceral fat tissue and abnormal values of MetS components may negatively affect metabolic control, thus accelerating the development of cardiometabolic complications.

Assessment of preservation of beta-cell function in children with long-standing type 1 diabetes with "ultrasensitive c-peptide" method.

INTRODUCTION: Type 1 diabetes mellitus is a disease caused by the autoimmune destruction of pancreatic beta-cells. It was previously believed that the loss of the endocrine function of the pancreas is total and inevitable. With the rise of new knowledge and new methods allowing to reliably measure c-peptide in the low plasma concentration range, we have learned otherwise. Some residual function of the beta-cells can be present even after decades of the course of the disease. The aim of the study was to evaluate the c-peptide level with routine laboratory and ultrasensitive methods in children with long-standing type 1 diabetes in relation to clinical characteristics. METHODS: We recruited 178 consecutive children with type 1 diabetes mellitus lasting at least 1 year, mean diabetes duration was 5.6 years. Basic anthropometric measurements were performed and blood samples were drawn. From patients history records we gathered data regarding the course of the disease and laboratory results previously acquired. Laboratory tests performed on the blood samples included HbA1c levels and c-peptide level measurement using classic (n=178) and ultrasensitive (n=160) method (Mercodia). Clinically relevant c-peptide level was set at 0.23 ng/ml according to the DCCT recommendations. RESULTS: Clinically relevant c-peptide was found in 54 of 160 (33.75%) patients. Patients with preserved c-peptide were older at the time of diagnosis, had longer clinical remission, and required lower total and basal doses of insulin. Significantly lower mean HbA1c from the last year, but higher HbA1c at the time of the diabetes diagnosis were found in the group with higher c-peptide levels. The comparison of the classic and ultrasensitive c-peptide tests revealed that both yield similar results. CONCLUSIONS: Our observation shows that 34% of young patients with long-standing type 1 diabetes have prolonged c-peptide secretion. We confirm the long-standing assumption that residual beta-cell function is beneficial for metabolic control of the patients. Classic method of the c-peptide measurement can be just as useful in clinical practice as the ultrasensitive one.

[Epidemiology of diabetes type 1 in children aged 0-14 in Podlasie Province in years 2005-2012]. / Epidemiologia cukrzycy typu 1 wsród dzieci w wieku 0­14 lat w makroregionie podlaskim w latach 2005­2012.

INTRODUCTION: Epidemiological studies performed during last decades in many European countries and in the world proved increasing incidence rate of diabetes, especially diabetes type 1 in children (DMT1). In Europe there is one of the highest diabetes incidence rate. The aim of the study was to estimate the incidence rate of diabetes type 1 in children aged 0-14 years in North-East Poland during 2005-2012 years and to analyse this rates in relation to age, gender and season of the diabetes onset. PATIENTS AND METHODS: The study was performed among patients staying under care of outpatient diabetes clinic of the Department of Pediatric, Endocrinologym Diabetology with Cardilogy Division, medical University of Bialystok, Poland. The DMT1 incidence rate was calculated as the number of all newly diagnosed cases per 100 000 persons 0-14 aged matched. RESULTS: During the studied 8-years- period DMT1 was diagnosed in 306 children aged 0-14 years, 159 boys and 147 girls, in Podlasie Province. The highest number of new cases was found in 2011: 49, and 2012: 47, with the lowest number in 2005 and 2009: 32 each year. The average incidence rate in the studied period was 20,84/100 000 population, aged matched. The lowest incidence rate was found in 0-4 yrs old group: 14,59 /100 000, in 5-9 years old group was: 22,04/100 000, and was highest in 10-14 years old group: 24,94/100 000. The highest increase in incidence rate was noted in the youngest group: from 9,14/100 000 in 2005, to 23,45/100 000 in 2012. The greatest number of new recognisions was found in from November to March, and the lowest number from June to August. CONCLUSIONS: 1. The DMT1 incidence rate among children aged 0-14 years, in Podlasie Province, during 2005-2012 years was 20,84/100 000. 2. Increase in incidence rate was observed in the studied period from 15,23/100 000 in 2005 to 26,71/100 000 in 2012. The highest increase in incidence rate, 2,5 times, was fund in the youngest group, aged 0-4 years. 3. The seasonal incidence of New onset was observed with the greater number in autumn-winter months.

Analysis of chosen polymorphisms in FoxP3 gene in children and adolescents with autoimmune thyroid diseases.

INTRODUCTION: Forkhead box P3 (Foxp3) is an important regulatory factor for the development and function of T regulatory (Treg) cells. Moreover, it has been established that deficiency of the Foxp3 gene in Treg cells suppresses their regulatory function leading to the development of autoimmune diseases especially autoimmune thyroid diseases. The aim of our study was to estimate the association of three polymorphism of FOXP3 gene with the predisposition to Graves' disease (GD) and Hashimoto's thyroiditis (HT) in children and adolescents. MATERIALS AND METHODS: The study was performed in the group consisting of 145 patients with GD (mean age, 16.5 ± 2 years), 87 patients with HT (mean age, 15.2 ± 2.2 years) sequentially recruited from the endocrinology outpatient clinic and 161 healthy volunteers (mean age, 16.3 ± 3 years). DNA was extracted from the peripheral blood leukocytes using a classical salting-out method. The three single nucleotide polymorphisms (SNPs) rs3761549 (-2383C/T), rs3761548 (-3279G/T) and rs3761547 (-3499T/C) in the FOXP3 gene were genotyped by TaqMan SNP genotyping assay using the real-time PCR method. The levels of thyroid hormones, TSH and anti-thyroid autoantibody were determined using chemiluminescence method. RESULTS: In our study, rs3761549G/A genotype was more frequent in female patients with GD in comparison to healthy female (15% vs. 7%, p = 0.033) with OR = 2.15 and 95% confidence interval for OR: 1.07-4.63. We have also observed rs3761547T/C to be more frequent in females with GD in comparison to control females, and this difference was close to statistically important (13% vs. 7%, p = 0.066) with OR = 1.99 and 95% confidence interval for OR: 0.96-4.48. There were no significant differences in males in analyzed SNPs and in females with rs3761548 SNP. CONCLUSION: In conclusion, these results may suggest that rs3761549G/A polymorphism in Foxp3 gene could contribute to GD development in females.

[Prevalence of autoimmune diseases and microangiopathy in children with diabetes type 1 over the years 2000-2010]. / Wystepowanie chorób autoimmunizacyjnych oraz mikroangiopatii u dzieci z cukrzyca typu 1 w latach 2000-2010.

INTRODUCTION: In the past decade the number of patients with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) has increased rapidly. Treatment of the disease is focused on proper physical development and the prevention of complications. Aim of the study was to analyze changes in the treatment and clinical picture of type 1 diabetes in children over the years 2000 to 2010 with particular emphasis on the presence of autoimmune diseases and microangiopathy. MATERIAL AND METHODS: The study included 567 children diagnosed with type 1 diabetes under the care of outpatient diabetes clinic. We compared 251 children, diabetes outpatient clinic patients in 2000, with 316 children in 2010. Data were obtained from the outpatient and hospital records. We compared baseline demographic, anthropometric data, treatment regimen, type of insulin, metabolic control, prevalence of autoimmune diseases and microangipathy. RESULTS: In 2010 there was a reduction in the age of diagnosis of diabetes from 10 to 8 years (p=0.039). Significantly increased the proportion of children treated with CSII (up to 60.1%) and decreased the percentage of children using conventional insulin for the benefit of insulin analogs. The increase in HbA1c from 7.4 to 8.0% (p<0.001) has been shown and increase in proportion of patients with HbA1c >7.5% in 2010. The percentage of children with obesity increased from 5.2 to 13.7% (p=0.004) and there was a significant increase in SDS-BMI. The percentage of children with autoimmune diseases such as celiac (from 0,4 to 7,3%, p<0,001) and thyroid (from 6.9 to 21.3%, p<0.001) has increased. The incidence of retinopathy decreased from 6 to 1% (p=0.04), and albuminuria decreased insignificantly. CONCLUSIONS: Over the last decade, a significant change in the method of treatment in children diagnosed with type 1 diabetes has occurred. The deterioration of metabolic control, despite the frequent use in the treatment of CSII, may be due to increased frequency of obesity and additional autoimmune diseases in today´s patients. More similar to physiologic way of insulin infusion in nowadays treatment may influence the decrease in the prevalence of retinopathy.

[Analysis of body composition with the use of bioimpedance in children with type 1 diabetes]. / Analiza skladu ciala z uzyciem metody bioimpedancji u dzieci z cukrzyca typu 1.

INTRODUCTION: Patients with diagnosed type 1 diabetes are a group particularly exposed to cardiovascular complications related to obesity. According to some previous data, one of the useful methods to analyze body composition may be a method of bioelectrical impedance. AIM OF THE STUDY: The aim of this research was to make an attempt of finding a correlation between anthropometric indicators and results of lipids profile and data obtained from bioelectrical impedance tests in children with diabetes. MATERIAL AND METHODS: The research sample comprised of 104 children with diabetes type 1 and 313 children without diabetes (a reference group). Anthropometric measurements were made in both groups. Furthermore data from lipids profile results was collected, as well as data from bioelectrical impedance analysis, such as: percentage and quantity (in kilograms) content of adipose tissue, fat-free body mass and total water content in the body. RESULTS: The tested and the reference groups were not different in respect of percentage content of adipose tissue, fat mass, fat-free body mass and total water content in the body. Substantially lower fat mass was noticed among children with overweight or obesity and diabetes than in the control children with overweight/obesity. In the whole sample a connection between percentage fat content and fat mass and standardized body mass index and waist circumference was noticed. The connection was stronger in the reference group, than among children with diabetes. Correlation between percentage content of adipose tissue with the fraction HLD-cholesterol and LDL-cholesterol and values of blood pressure were observed in the whole sample. CONCLUSIONS: The results of our research the confirm correlation between anthropometric parameters and the data collected from bioelectrical impedance. Those connections are, however, stronger in the group of children without diabetes than with diabetes, which questions the usefulness of this method in evaluation of adipose tissue among children treated with insulin.

[Urolithiasis risk factors in obese and overweight children]. / Czynniki ryzyka tworzenia kamieni nerkowych u dzieci z otyloscia i nadwaga

INTRODUCTION: Childhood obesity is becoming a worldwide epidemic and its metabolic and cardiovascular complications may already be evident at a young age. Several epidemiologic studies in adults have clearly demonstrated that obesity and overweight increase the risk of kidney disease and urolithiasis. AIM OF THE STUDY: The purpose of this study was to evaluate the relationship between overweight and obesity and urolithiasis risk factors in children. MATERIALS AND METHODS: The main kidney stones risk factors in urine such as calcium concentration, oxalate concentration, citrate concentration, pH of urine as well as BRI (Bonn Risk Index) were analyzed in 249 overweight and obese children (study group) and in 281 children with normal weight (control) at the age of 3 to 18 years old. RESULTS: In the study group the mean oxalate concentration was significantly higher than in the control (0.52±0.48 vs. 0.26±0.12; p <0.05). The mean calcium concentration of overweight/obese patients was higher than that of normal body weight and the difference was close to statistically significant (3.23±2.55 vs 2.58±1.59; p=0.0537). The mean urine pH in the study group was 6.28±0.46 and was significantly lower (p <0.05) than the mean urine pH in the control, witch was 6.40±0.47. The mean citrate concentration among overweight/obese patients was significantly lower than in control (431,2±309,5 vs. 637,2±310,7; p <0.05). CONCLUSIONS: Our results suggest that obesity or overweight at a young age are associated with an increased risk of kidney stones. Weight loss might be explored as a potential treatment to prevent kidney stone formation.