Growth Differentiation Factor 15: Relation to vascular complications in patients with type 1 Diabetes Mellitus

Abstract

Diabetes mellitus is the third most common chronic condition in childhood and poor glycemic control leads to serious short-term and life-limiting long-term complications (McNamara et al., 2010). Type 1 diabetes mellitus is caused by insulin deficiency following destruction of the insulin-producing pancreatic beta cells. It most commonly presents in childhood but one- fourth of cases are diagnosed in adults (Lynne et al., 2011). Diabetic nephropathy is a chronic progressive kidney disease with high morbidity and mortality rate and is characterized by an early elevation of arterial blood pressure, increasing albuminuria and decline in glomerular filtration rate (GFR) of approximately 10 to 12ml/min/year and extremely high risk of cardiovascular disease without antihypertensive treatment (Fioretto and Mauer, 2007). It is the leading cause of kidney disease in patients starting renal replacement therapy and affects nearly40% of type 1 and type 2 diabetic patients and it is unique to type 1 diabetic patients (Fioretto et al., 2007). So in the view of these data, our study was aiming to asses the Growth differentiation factor 15 (GDF 15) in children and adolescents with type 1 diabetes mellitus and its relationship to diabetic microvascular complications (nephropathy, retinopathy and sensory neuropathy) as well as to various clinical and laboratory parameters of diabetes. Our study was a case control study being conducted on children and adolescents following up at Diabetes Clinic, Children's Hospital, Ain-Shams University. It included 60 patients with type 1 diabetes mellitus. They were further subdivided into two subgroups: Group 1, adolescents with DM type1 without micro-albuminuria (N=30); Group 2, adolescents with DM type1 and positive micro-albuminuria (N=30). They were 23 (38.3%) males and 37 (61.7%) females; whose mean age was 12.25 ± 2.39 years (range 10-17) and mean disease duration was 8.2±2.576 years (range 5-15). Thirty age and sex matched healthy individuals (with no history or clinical evidence of DM, hypertension, and cardiovascular disease) served as a control group. They were 11(36.7%) males and 19 (63.3%) females; whose mean age was 11.80±1.74 years (range 10-16). Our study showed that there is no significant difference between diabetic patients and controls regarding age and gender, indicating well cross matched groups. There were a statistically significant difference between diabetic patients and controls regarding pulse, diastolic blood pressure, height, waist and hip circumference, waist and hip ratio, and lipid profile. Our study showed that diabetic patients with microalbuminuria had a significant correlation with increased serum HbA1c (p<0.05). In this study, the mean of Growth differentiation factor 15 was higher in diabetic patients than in the control group and this difference was highly significant statistically, while a non significant difference was found between patients subgroups. A correlation between GDF 15 and diabetic retinopathy in the patient groups was done. There were statistically significant differences between them (p-value <0.05).