INFLUENCE OF ENVIRONMENTAL AND SUPPLEMENTARY VITAMIN (D) ON THE PROGNOSTIC PATHWAY OF TYPE1 DIABETES AMONG CHILDREN

Abstract

diabetes mellitus ‘DM’ has been defined as being a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of DM include long term damage, dysfunction, and failure of various organs. Diagnosis is made by the presence of classic symptoms of hyperglycemia and an abnormal blood test, a plasma glucose concentration ≥ 7 mmol/l (or 126 mg/dl) or ≥ 11.1 mmol/l (or 200 mg/dl) two-hours after a 75 g glucose drink (ADA, 2017). When using glycosylated hemoglobin (HbA1C) to diagnose DM, it is important to recognize that HBA1C is an indirect measure of average blood glucose levels and to take other factors into consideration that may impact hemoglobin glycation independently of glycemia including age, race/ethnicity, and anemia/ hemoglobinopathies (Nowicka et al, 2011). T1DM usually develops during childhood and adolescence and patients require lifelong insulin injections for survival, it is one of the most common endocrine and metabolic conditions in childhood. Data from large epidemiological studies worldwide indicate that on an annual basis, the overall increase in the incidence of T1DM is around 3% and about 78,000 children under age 15 years develop T1DM worldwide (IDF, 2013). The wide variation in incidence can hardly be explained by genetic factors alone. Environmental factors have long been implicated in the pathogenesis of T1DM both as initiator and potentiators of pancreatic β-cells destruction (Knip and Simell, 2012). Among Eastern Mediterranean and Middle Eastern countries, the largest contribution to the total number of estimated childhood T1DM cases comes from Egypt which accounts for about a quarter of the region’s total. The incidence has been estimated as 8/100 000 per year (Egypt) in children under the age of 15 years (Soltèsz, et al, 2006). While in Nile delta, the calculated age-adjusted incidence of T1DM in 2011 was 3.1 in 100,000/year, whereas the calculated age-adjusted prevalence of T1DM in the same year was 26.8 in 100,000/year (El-Ziny et al, 2014).