Meal-Related Asprosin Serum Levels Are Affected by Insulin Resistance and Impaired Fasting Glucose in Children With Obesity

Asprosin physiologically increases in fasting conditions and decreases with refeeding and has been implicated in glucose homeostasis. An alteration of meal-related circadian oscillation of asprosin has been suggested in adults affected by type 2 diabetes mellitus.Aims of this study were to test the hypothesis of an alteration in the meal-related variation of asprosin levels in non-diabetic children and adolescents with obesity and to assess which metabolic variables condition this variation in non-diabetic children and adolescents with obesity. This is a cross-sectional study which included 79 children and adolescents with obesity. Children underwent clinical and biochemical assessments, including oral glucose tolerance test (OGTT), and liver ultrasound evaluation. Asprosin serum levels were measured by an enzyme-linked immunosorbent assay at a fasting state and at the 120-minute OGTT timepoint (2h-postprandial asprosin). Fasting and 2h-postprandial asprosin serum levels did not significantly differ in the entire study population (374.28 ± 77.23 vs 375.27 ± 81.26;p=0.837). 55.7% of patients had a significant increase in 2h-postprandial asprosin compared with fasting levels. The asprosin level increase condition was significantly associated with HOMA-IR (OR,1.41; 95%CI,1.005-1.977; p=0.047), fasting glycaemia (OR,1.073; 95%CI,1.009-1.141;p=0.024) and HOMA-B (OR,0.99; 95%CI,0.984-0.999; p=0.035). Moreover, the IFG condition was associated with the increase in asprosin levels (OR, 3.040; 95%CI, 1.095-8.436; p=0.033), even after adjustment for HOMA-IR, BMI SDS, sex and pubertal stage. Insulin resistance and IFG influence meal-related changes of asprosin serum levels in our study population of obese, non-diabetic, children. Alteration of asprosin circadian secretion might be an early biomarker of impaired glucose regulation in obese children with insulin resistance.

Frequency of wound infection in children undergoing appendectomy for acute versus perforated appendicitis.

Objective: To find out the frequency of wound infection in children undergoing appendectomy for acute vs perforated appendicitis. Study Design: Observational and Cross-sectional study. Setting: Department of Surgery at Children’s Hospital and the Institute of Child Health Lahore. Period: January 2018 to July 2018. Material & Methods: Data was collected by using Random sampling technique. Patients of both genders were included. Diabetic children were excluded. Questionnaire was developed with the help of experts, literature review and data collection. Results: A sum of 120 patients were included with mean age of 9 + 1.94 SD minimum was 7 and maximum was 13. Some patients have acute appendicitis 20(16.67%) and 100 (80.33) perforated appendix undergone appendectomy. Conclusion: The findings of the study indicated that there is less wound infection in acute appendix but more wound infection observed in perforated appendix after appendectomy.

Autoimmune thyroid disease in diabetic children and adolescents: a single center study from south Punjab

Objective: To evaluate the prevalence of autoimmune thyroid disease (AITD) in diabetic children in south Punjab. Methods: This was an observational cross sectional study from Jan 2019 to Dec 2019 in the outpatient diabetic clinic of the department of pediatric endocrinology at Children Hospital and The Institute of Child Health Multan. A total of 161 consecutive patients of both genders with TIDM were enrolled in this study after taking informed consent. Blood samples for Thyroid functions testes including thyroid stimulating hormone (TSH), free thyroxin (fT4), Thyroid peroxidase antibody (TPO-Ab), thyroglobulin antibody (TG-Ab) and glycosylated hemoglobin (HbA1C) level were sent. Results: Among diabetic children males were 83 (51.6%). Age range was 2-15 years. Mean age and standard deviation was 9.7± 4.3. TPO-Ab was positive in 34 patients (21.1%) and TG-Ab in 27 patients (16.7%), whereas both antibodies were positive in 17 patients (10.5%). Six patients (3.7%) had evidence of subclinical hypothyroidism, 8 patients (4.9%) had overt hypothyroidism and 1 patient (0.62%) had hyperthyroidism Conclusion: The prevalence of AITD among children and adolescents with type 1 diabetes mellitus was 21.1% in our study. Hypothyroidism was more prevalent in these children compared to hyperthyroidism. All diabetic children should be screened for AITD. Thyroid functions should be checked where TPO antibody is positive. Keywords: Autoimmune thyroid disease, anti thyroid peroxidase antibody, anti thyroglobulin Continuous...

Impact of iron deficiency anemia on HbA1c level in non-diabetic children

Background and objective: HbA1c has been endorsed by the American Diabetes Association and World Health Organization to diagnose and monitor diabetes mellitus. Its value is directly proportional to the blood glucose level. However, besides the blood glucose level, other factors like iron deficiency anemia can affect HbA1c level. We conducted this study to reveal the impact of iron deficiency anemia on HbA1c level and to assess whether HbA1c result changes after the correction of iron deficiency anemia. Methods: Twenty five non-diabetic children who were confirmed to have iron deficiency anemia were enrolled. HbA1c, hemoglobin, serum iron, and ferritin were measured and compared at baseline and post-correction of iron deficiency anemia with a three-month age-appropriate dose of iron therapy. The baseline results were compared with 25 age- and sex-matched normal controls. Results: Children with iron deficiency anemia had significantly higher HbA1c level (6.144±0.6312, P <0.001) than the control group (5.032±0.5558, P <0.001). After three months of treatment of iron deficiency anemia, HbA1c significantly dropped (from 6.144±0.6312, P <0.001 to 5.604±0.51, P <0.001). Conclusion: This study concluded that HbA1c is inversely proportional to iron deficiency anemia in non-diabetic children, and treatment of iron deficiency anemia led to a drop in HbA1c level. Due to this false elevation of HbA1c by iron deficiency anemia, iron deficiency anemia should be considered and excluded before making the diagnosis or deciding on any therapeutic change in diabetic children. Keywords: Iron deficiency anemia; HbA1c; Non-diabetic children.

Awareness of Parents Regarding DKA Symptoms in their Children with Type I DM

Background: Diabetic ketoacidosis (DKA) is a common emergency and life-threatening illness. Also, if not detected early, early treatment in the emergency room can cause serious complications. The goal of managing type 1 diabetes is to maintain the correct levels of blood sugar, glycated hemoglobin (HbA1c), blood pressure, lipid levels, and body weight while avoiding hypoglycemia. Treatment of type 1 diabetes requires proper insulin treatment, proper nutrition, physical activity, preventive education, and patient self-care Objective: The purpose of this study is to determine parental perceptions of DKA symptoms in children with type 1 diabetes in the Northern Region of Saudi Arabia. Methods: In the Northern Region of Saudi Arabia, a cross-sectional study was conducted from November 2020 to May 2021 among parents with diabetic children at the Diabetes Center in the Northern Region of Saudi Arabia using a pre-designed online questionnaire distributed on social media web-sites to collect data. Data was analyzed by using statistical package for the social sciences (SPSS, version 23) and results was presented by tabular and graphical presentation according to the study objectives. Results: only 42.9% of our participants responded that they have good knowledge about DKA. 19.2% thought it only occurs in children. 43.3% of our participants knew that DKA is a complication of diabetes due to hyperglycemia. Regarding the source of information about DKA among our participants, our data demonstrated that only 22.9% of our participants got their information about DKA from the doctors, and 31.8% of the participants had the internet as their source of information regarding DKA. In the current study, 14% of the participants said that they had a child had DKA at least one, and 91.6% of them were admitted to the hospital. There was a significant relation with gender, age of the parent, and educational level, while it showed insignificant relation with marital status. Conclusion: In conclusion, knowledge of most of parents of diabetic children about diabetic ketoacidosis is poor. Their main knowledge source is not trustful or adequate. Their main knowledge source is not trustful or adequate. Therefore, we recommend policy makers to held health education to parents and/or caregivers of type 1 diabetic children regarding all aspects of DKA. It must be properly achieved in a structured manner based on a general outline that should include education at the onset of treatment and then repeated based upon an annual assessment of patients’ training needs or upon their own request. Areas of poor knowledge related to diabetes and diabetic ketoacidosis should be emphasized during health education sessions.

Clinical Significance of the Fetuin-A-to-Adiponectin Ratio in Obese Children and Adolescents with Diabetes Mellitus

Fetuin-A and adiponectin are inflammatory cytokines associated with obesity and insulin resistance. This study aimed to examine the fetuin-A-to-adiponectin ratio (FAR) in diabetic children and to determine the role of FAR. A total of 54 children and adolescents with diabetes mellitus (DM) and 44 controls aged 9–16 years were included in this study. Clinical characteristics, including plasma fetuin-A and adiponectin levels, were compared with respect to body mass index (BMI) and diabetes type. Of 98 children, 54.1% were obese, whereas 18.4% were obese and diabetic. FAR was higher in obese children with DM than in non-obese children and also in type 2 DM children than in type 1. FAR showed a stronger association with BMI than with fetuin-A and adiponectin individually, and its association was more prominent in diabetic children than in controls. BMI was a risk factor for increased FAR. Plasma fetuin-A was elevated in obese children, and its association with insulin resistance and β cell function seemed more prominent in diabetic children after adjustment for adiponectin. Thus, FAR could be a useful surrogate for the early detection of childhood metabolic complications in diabetic children, particularly those who are obese.

Role of motivational interviewing in type 1 diabetes mellitus with sub optimal glycemic control.

Objective: To determine the role of motivational interviewing in better management of diabetes mellitus in children. Study Design: Observational Cross Sectional Study. Setting: Children Hospital & Institute of Child Health Multan. Period: November 2019 to May 2020. Material & Methods: Fifty-six poorly controlled follow up diabetic children of 8 to 15 years of both sexes, with HBA1c more than 10 %were included. Their social status, educational status whether studying or not was noted. All patients were advised subcutaneous Insulin according to weight. All children were counselled and motivated for self-care, problem identification and solution, and proper diabetic management by a team consisting of an endocrinologist, a dietitian, a psychologist and a nurse. Glycemic control was assessed using HbA1c, at 1st visit, 3rd and 6th month. A decline in HbA1c by ≥1% was considered for good control of DM, while ≤1% decrease was taken as poor control of DM. Data was analyzed by using SPSS version 20. Result: Out of 56 patients. 50%(n=28) were females and ,50%(n=28) were males.42.9 % (n=24) patients were age ranges between 8 to 11.5 years while 57.1%(n=32) more than 11.5 to 15 years, with mean age of 11.8±1.97 years 28.6% diabetic children belonged to lower, 57.1% middle while 14.3% upper socioeconomic status. 69.4%children were going to school while 27.6% were not studying. Good glycemic control was observed in 85.7% diabetic children which is statistically significant (p-value <0.001). Conclusion: Motivational interview proved to be a good tool for the better outcome of diabetic children, who need both knowledge and practical communication for their management regarding behavioral changes, lifestyle issues and self-management. It must be a part of diabetic management programs.

Glycosylated Hemoglobin Levels Among Non-Diabetic Children With Sickle Cell Anemia At Muhimbili National Hospital. A Case For Establishing Normal Values

BackgroundImprovement in the management of children with SCA, has led to increase in their lifespan. However, the increased lifespan, has been accompanied with emergence of various endocrinopathies such as Diabetes mellitus (DM).Glycosylated Hemoglobin (HbA1c) levels have been found to be lower in children with SCA compared to children without SCA in various studies. This can lead to missed children with DM hence delaying their treatment. There is a need to establish normal ranges of HbA1c levels corresponding to children with SCA.ObjectiveTo determine normal range of HbA1c levels among non-diabetic children with SCA attending clinics at Muhimbili National Hospital in Dar-es-salaamMethodologyThis was a hospital-based cross sectional study conducted at Paediatric clinics in Muhimbili National Hospital involving children from 9 months to 14 years. The study was approved by Institutional review Board of MUHAS. A written informed consent was obtained.120 children with SCA and 40 children without SCA were recruited. Data was reported as median and IQR or as mean ± standard deviation. Chi-square was used for categorical data while independent t-test and Mann Whitney test were used for continuous data. ResultsThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Median HbA1c level in children with SCA was 4.2% with IQR of (4.1% - 4.6%) while for children without SCA median HbA1c levels was 5.3% with IQR of (4.9% - 5.5%). The median HbA1c level was significantly lower in children with SCA than children without SCA.Conclusion and RecommendationThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Children with SCA had lower levels of HbA1c compared to children without SCA. Health personnel are advised to use HbA1c reference ranges obtained from this study when screening for Diabetes mellitus in children with SCA.