Changes in early optical coherence tomography angiography among children and adolescents with type 1 diabetes: Relation to fibroblast growth factor 21.

AIMS: Current diagnostic and treatment modalities target late stages of diabetic retinopathy (DR) when retinopathy has already been established. Novel and more sensitive strategies are needed. Optical coherence tomography angiography (OCTA) permits non-invasive visualisation of retinal microcirculation. Fibroblast growth factor-21 (FGF21) plays an important role in glucose and lipid homoeostasis. This study assesses early OCTA changes among children and adolescents with type 1 diabetes (T1DM) compared to fundus photography and correlates them to diabetes-duration, glycaemic control, and FGF21; hence, it determines their value in early detection of DR. METHODOLOGY: Hundred children and adolescents with T1DM were assessed for diabetes-duration, insulin therapy, hypoglycemia, and diabetic-ketoacidosis frequency, Tanner staging, glycated-haemoglobin (HbA1c), fasting lipids, urinary albumin/creatinine ratio, and serum FGF21. OCTA and fundus photography were done for the studied patients and 100 age, gender, and Tanner matched healthy controls. RESULTS: The mean age of the children and adolescents with T1DM was 10.84 years, their mean diabetes-duration was 3.27 years and their median FGF21 was 150 pg/ml. FGF21 was significantly higher among children and adolescents with T1DM than controls (p < 0.001). Children and adolescents with T1DM had a significantly larger foveal avascular zone (FAZ) and lower peripapillary and inside-disc capillary densities (p < 0.05); with no significant fundus photography difference (p = 0.155) than controls. FAZ was positively correlated and peripapillary and inside-disc capillary densities were negatively correlated with diabetes-duration, HbA1c, FGF21, and Tanner stage. FGF21 was significantly higher in T1DM children and adolescents having OCTA changes compared to those with normal OCTA (p = 0.002). Multivariate-regression revealed that FAZ is independently associated with diabetes-duration, HbA1c and FGF21. CONCLUSIONS: OCTA changes start early in children and adolescents with T1DM long before the fundus changes. These changes are correlated with diabetes-duration, puberty, glycaemic, and FGF21.

Assessment of fibroblast growth factor 21 in children with type 1 diabetes mellitus in relation to microvascular complications.

INTRODUCTION: Type 1 diabetes mellitus (DM1) represents a growing global health problem with significant morbidity. Fibroblast growth factor 21 (FGF21) is an adipokine expressed predominantly in the liver that plays an important role in metabolic regulation. AIM OF THE STUDY: This study assesses FGF21 levels in children with DM1, in comparison to controls, and correlates them with diabetes duration, glycated haemoglobin (HbA1c), and diabetic microvascular complications. MATERIAL AND METHODS: Fifty children with DM1, aged between 5 and 16 years, were studied regarding their diabetes duration, HbA1c, urinary albumin creatinine ratio (UACR), fundus, and FGF21 level. They were compared to 50 healthy controls. RESULTS: The median FGF21 of the studied children with DM1 was 150 pg/ml, range 50-350 pg/ml; while that of the controls was 35 pg/ml, range 20-50 pg/ml. FGF21 level was significantly higher in children with DM1 than in controls ( p < 0.001). Moreover, it was significantly and positively correlated with diabetes duration, mean blood glucose level, and HbA1c ( p < 0.001, p = 0.015, p = 0.018, respectively). Interestingly, the FGF21 level was not significantly elevated in children with DM1 having diabetic nephropathy and retinopathy ( p = 0.122, p = 0.298, respectively). CONCLUSIONS: FGF21 is significantly higher among children with DM1 than in controls. However, its role in diabetic microvascular complica-tions needs further assessment.