CLINICAL AND LABORATORY FEATURES, COMORBID CONDITIONS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS DEPENDING ON DISEASE DURATION

Abstract

Introduction. Type 1 diabetes mellitus is one of the most common chronic endocrine diseases in children, characterized by an absolute insulin deficiency due to autoimmune damage to the β-cells of the pancreas. Type 1 diabetes shows a tendency for rapid growth, making it one of the most pressing issues in pediatric endocrinology. Identifying specific clinical and laboratory features, comorbidities, and complications of diabetes is an important aspect for proper treatment and improving the quality of life of patients. Hyperglycemia, arterial hypertension, and dyslipidemia are the main modifiable risk factors contributing to the development of micro- and macrovascular complications in type 1 diabetes. Children suffering from type 1 diabetes are significantly more prone to developing autoimmune disorders compared to their peers from the general population.

Objective: To investigate the clinical and laboratory features and comorbid conditions in children with type 1 diabetes depending on the duration of the disease. To identify the main complications of diabetes and comorbid conditions in children with type 1 diabetes.

Materials and methods. A total of 55 individuals were examined, who were undergoing treatment at the Communal non-profit enterprise of Sumy Regional Council “Regional Children’s Clinical Hospital”. Of these, 47 children had type 1 diabetes, and 8 were healthy children without diabetes or kidney pathology. The patients were divided into 3 groups depending on the duration of the disease: those with newly diagnosed diabetes for up to one year – 11 (23.4%) individuals, those with a disease duration of one to five years – 24 (51.1%) children, and those with a disease duration of more than five years – 12 (25.5%) individuals. The complex laboratory investigations included the determination of the glycemic profile (glucose oxidase method), glycated hemoglobin, clinical blood and urine tests, as well as the biochemical composition of the blood serum (total protein, albumin, creatinine, urea, bilirubin, cholesterol, β-lipoproteins, ALT, AST). The studies were conducted using the semi-automatic biochemical analyzer Microlab 300 (Vital Scientific B.V., Elitech Holding, Netherlands), hematological analyzers ABX Micros 60 (HORIBA ABX, France) and HumaCount 80TS (Human GmbH, Germany). Glycated hemoglobin levels were determined using CLOVER A1c Infopia (Infopia Ltd., South Korea). Urinary ketones were tested using a qualitative method with indicator test strips Acetontest ("Norma-Trade", Ukraine). The function of the glomerular apparatus of the kidneys was evaluated by calculating the glomerular filtration rate using the Schwartz formula. Statistical analysis of the results was performed using Microsoft Excel 2016 and StataNow/SE 18.5.

Results. Statistically significant differences in glycated hemoglobin levels were found between the group of children with diabetes lasting from one to five years and the group of children who had been diabetic for more than five years (p = 0.0402). In all examined patients, clinical blood test parameters were within the age-specific norms. An increase in creatinine and β-lipoprotein levels was observed, with a weak inverse correlation between them (r = -0.2286). Ketonuria of varying degrees was recorded in 9 (19.2%) children with type 1 diabetes. No statistically significant differences in glomerular filtration rate levels were found between the groups of examined children (p = 0.7997). Among children with diabetes duration of less than one year, diabetic hepatosis was most commonly diagnosed in 6 (54.5%) individuals, and retinopathy in 3 (27.3%) individuals. In patients with diabetes from one to five years, these complications were found in 11 (45.8%) individuals and 2 (25%) individuals, respectively. In children with diabetes for more than five years, diabetic hepatosis occurred in 4 (33.3%) individuals, retinopathy in 2 (16.7%) individuals, and diabetic neuropathy in 1 (8.3%) individual. Signs of autonomic cardiovascular neuropathy were recorded in 2 (8.3%) children in the group with diabetes duration from one to five years and in 1 (8.3%) child in the group with diabetes duration over five years. Lipodystrophy of the shoulders and thighs was found in 1 (4.2%) individual in the group with diabetes duration from one to five years. Chronic gastroduodenitis was diagnosed in 10 (21.3%) children with type 1 diabetes. Among patients with diabetes duration less than one year, chronic gastroduodenitis was found in 2 (18.2%) individuals, in 5 (20.8%) children with diabetes duration from one to five years, and in 3 (25%) individuals with diabetes for more than five years. Neurocirculatory dystonia was observed in 2 (18.2%) children with diabetes of less than one year, in 2 (8.3%) patients with diabetes duration from one to five years, and in 1 (8.3%) individual with diabetes duration over five years. Autoimmune thyroiditis was diagnosed in 3 (12.5%) children with diabetes duration from one to five years and in 1 (8.3%) child among those with diabetes for more than five years. Among ophthalmological pathologies, hypermetropia was the most common, found in 3 (27.3%) children with diabetes duration less than one year and in 1 (8.3%) child with diabetes duration over five years. Myopia was recorded in one child from the group with diabetes duration from one to five years, and accommodation spasm and artifakia were found as isolated cases among patients with diabetes for more than five years.

Conclusions. The current course of type 1 diabetes in children may not be accompanied by changes in hematological parameters. Children with diabetes duration from one to five years more frequently develop complications such as diabetic hepatosis and retinopathy. Among comorbid conditions in children with type 1 diabetes, the most common are chronic gastroduodenitis and thyroid pathology. Gastrointestinal disorders were associated with increased levels of β-lipoproteins.