Body composition in children with Type 1 Diabetes and its relationship to glycemic control and cardiovascular risk

Abstract

Type 1 diabetes mellitus is one of the most common autoimmune diseases; it is characterized by an absolute deficiency of insulin secretion and caused by autoimmune destruction of ß cells within the pancreatic islet. Dietary recommendations and regular physical activity for diabetic children should be encouraged. Many therapeutic options for children with T1D are available which include multiple daily injections of rapid acting bolus insulin with meals combined with daily basal insulin. Obesity is a modifiable cardiovascular risk factor so careful management of weight gain should be included in the diabetes care. HbA1c is one of several measures to assess glycemic control and elevated HbA1c predicts microvascular and macrovascular complications. Changes in lipids together with high sensitivity CRP currently is associated with increased cardiovascular risk and also associated with obesity in T1D. The present study was conducted to examine the relationship between body composition changes in newly diagnosed children with T1DM and between glycemic control (HbA1c) and markers of cardiovascular risk (hsCRP and lipid profile parameters and risk ratios), to evaluate gender differences in body composition, glycemic control and cardiovascular risk markers and to find predictors of glycemic control in type 1 diabetic children. This prospective interventional case- control study included 43 newly diagnosed T1D patients (after 1 week of diagnosis) recruited from the Diabetes Clinic, Mansoura University Children Hospital and Pediatric Diabetes Centre in AlFardos health insurance clinic in Mansoura, they were 17 males and 26 females, their ages ≤9 years and they were receiving intensive therapy of human insulin.Patients with other chronic diseases, other autoimmune diseasesand complicationswere excluded from the study. Our study also included 20 apparently healthy children matched in age and sex with patients were recruited from the outpatient clinics of Children's Hospital, Mansoura University. They were 12 females, 8 males. Informed verbal assent was taken from children over 8 years as well as written informed consent was obtained from care givers after explanation of the nature and aims of the study. All patients were subjected to full medical history, anthropometric measures, BP done at 1 week, 6 months, and at 1 year after diagnosis while for controls basal and after one year were only recorded for weight, height, BMI, BMI-z score. Whereas; BP, WC,WC/HC were done for the control once all over the study. HbA1c was done at 1 week, 6 months, and at 1 year for patients and once for control while high sensitivity C – reactive protein and complete lipid profile were done at 1 week and after 1 year for patients and once for control. Body composition was measured by DXA, providing measures of tissue, lean and fat mass at 1 week, 6months and 1 year after diagnosis for patients and for the controls twice with one year in between. All patients received intensive insulin therapy,health education about dealing with the disease and healthy diet.