الفهرس 
Type 1 Diabetes MellitusOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Summary
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in pediatric patients. The incidence of T1DM among children is rising worldwide. The overall annual increase is estimated at 3% with approximately 70,000 children worldwide expected to develop T1DM every year (IDF, 2013).
Patients with T1DM are at high risk of developing other autoimmune diseases, such as autoimmune thyroiditis (AIT) and celiac disease (CD) Moreover, T1DM can lead to numerous complications in pediatric patients. (Al-Agha et al, 2015)
The major effect of intensive islet-cell-specific autoimmunity seems to accelerate target organ destruction, resulting in rapid progression to clinical diabetes and leading to total β-cell destruction after the diagnosis. (Sabbah et al, 1999)
Since both T1DM and CD show the same genetic background and an abnormal small intestinal immune response with inflammation and a variable grade of enteropathy, serological screening for CD should be performed in all T1DM patients by means of antibodies to tissue transglutaminase at T1DM onset. (Volta et al., 2011)
The study aimed to co-relate the presence of Anti-insulin Antibody and / or Anti-tissue Transglutaminase Antibody in type 1 diabetic patients regularly attending the pediatric diabetes clinic at Ain Shams University with the short and long term complications.
It was conducted in the period from October 1st 2013 till June 4th 2014 and included 151 children and adolescents with type 1 DM, who were regularly followed up in the clinic, they were 72 males (47.7%) and 79 females (52.3%) , their ages ranged from 2 -17 years with mean age 10.96 3.95 years and their disease duration ranged from 0.1- 16 years with mean of 3.84 3.41 year.
All patients were subjected to: full history taking, thorough clinical examination and laboratory investigation including: HbAc1%, Serum Anti insulin Antibody and Anti-tissue transglutaminase Antibody.
The results of the study showed:
- Percentage of female patients in the study was slightly higher than males.
- Almost forty percent (39.7%) of our studied population had family history of Diabetes whether type 1 or type 2.
- Eleven patients (7.3%) had family history of other autoimmune diseases. While only 3 patients (2%) were found to have other autoimmune diseases than type 1 diabetes.
- As for symptoms suggestive of celiac disease; the most common symptoms encountered were easy fatigability and abdominal distention.
- Only 1.3% (2/151) of patients was below the 5th centile for weight, whereas 9.3% (14/151) were short.
- Three patients of 151 (2%) were hypertensive.
- Thirty patients of out the total group of 151 diabetics had one or more microvascular complications.
- About three quarters were poorly controlled.
Due to sampling errors, 128 patients out of our total number of patients (151) were serologically screened for the presence of Anti-insulin Antibodies and Anti-Tissue Transglutaminase Antibodies.
- Fifty three (53) patients out of (128) were positive for Anti-insulin Antibody giving a sero-positivity of 41.4%, whereas 3 patients (2.34%) displayed positive results for Anti-Tissue Transglutaminase Antibodies, one of them (0.8%) showed positivity to both antibodies.
- No significant relation was found between positivity of antibodies, either.
- No relation was found between positivity of Anti-insulin antibodies and Anti-tissue Transglutaminase antibody titre but patients having positive Anti tissue transglutaminase antibodies displayed lower titre of anti-insulin antibodies.
- There was no significant difference in gender as regard positivity to any of the antibodies.
- No significant relation was found between Anti-insulin Antibodies’ positivity and the patients’ age or age of diabetes onset. On the other hand, patients positive for Anti-Tissue Transglutaminase Antibodies were younger in age and they seemed to have earlier diabetes onset (p-value =0.006).
- Frequency of diabetics receiving an insulin dose between 1-2 IU/Kg/day was higher among those expressing Anti- insulin Antibody positivity. Lower insulin requirements were observed among those with negative Anti- insulin Antibody even though there was no significant relation between insulin requirements and Anti-tissue Transglutaminase positivity (p- value>0.05).
- No relation was found between Antibodies’ positivity and diabetic ketoacidosis or hypoglycemic attacks.
- Anti- insulin Antibodies are more common in patients with family history of diabetes.
- No significant relation between Antibodies’ positivity and family history of autoimmune diseases.
- No significant relation was found between suggested celiac symptoms and the positivity of either of the antibodies.
- There was no significant difference in weight, height, BMI and blood pressure percentiles between patients showing positivity or negativity to either Anti-insulin Antibodies or Anti-tissue Transglutaminase Antibodies. where (p- value>0.05)
- No significant relation was found between Antibodies’ positivity and glycemic control (p- value>0.05).
- Although most of the patients who had Neuropathy showed positivity to Anti-insulin Antibodies (p-value <0.05) but no significant relation was found between the presence of microvascular complications and the positivity of Anti-tissue transglutaminase Antibodies. Also most of patients (14/23) with microvascular complications were seropositive for Anti-insulin antibody titer.
- Anti-insulin antibody differentiated those with microvascular complication with sensitivity and specificity of 69.6% and 57% respectively when considering the cut-off point was 8.95 U/ml
This study has proved that the screening of autoantibodies in type 1 diabetic patients could reveal subclinical cases of coeliac disease. It also has proved that follow-up of patients with positive autoantibodies is a must because further deterioration of the respective organs can be-expected.