الفهرس 
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Abstract
Type 1 diabetes mellitus is one of the most common autoimmune diseases; it is characterized by an absolute deficiency of insulin secretion and caused by autoimmune destruction of ß cells within the pancreatic islet. Dietary recommendations and regular physical activity for diabetic children should be encouraged. Many therapeutic options for children with T1D are available which include multiple daily injections of rapid acting bolus insulin with meals combined with daily basal insulin. Obesity is a modifiable cardiovascular risk factor so careful management of weight gain should be included in the diabetes care. HbA1c is one of several measures to assess glycemic control and elevated HbA1c predicts microvascular and macrovascular complications. Changes in lipids together with high sensitivity CRP currently is associated with increased cardiovascular risk and also associated with obesity in T1D.
The present study was conducted to examine the relationship between body composition changes in newly diagnosed children with T1DM and between glycemic control (HbA1c) and markers of cardiovascular risk (hsCRP and lipid profile parameters and risk ratios), to evaluate gender differences in body composition, glycemic control and cardiovascular risk markers and to find predictors of glycemic control in type 1 diabetic children.
This prospective interventional case- control study included 43 newly diagnosed T1D patients (after 1 week of diagnosis) recruited from the Diabetes Clinic, Mansoura University Children Hospital and Pediatric Diabetes Centre in AlFardos health insurance clinic in Mansoura, they were 17 males and 26 females, their ages ≤9 years and they were receiving intensive therapy of human insulin. Patients with other chronic diseases, other autoimmune diseases and complications were excluded from the study.
Our study also included 20 apparently healthy children matched in age and sex with patients were recruited from the outpatient clinics of Children’s Hospital, Mansoura University. They were 12 females, 8 males.
Informed verbal assent was taken from children over 8 years as well as written informed consent was obtained from care givers after explanation of the nature and aims of the study.
All patients were subjected to full medical history, anthropometric measures, BP done at 1 week, 6 months, and at 1 year after diagnosis while for controls basal and after one year were only recorded for weight, height, BMI, BMI-z score. Whereas; BP, WC, WC/HC were done for the control once all over the study.
HbA1c was done at 1 week, 6 months, and at 1 year for patients and once for control while high sensitivity C – reactive protein and complete lipid profile were done at 1 week and after 1 year for patients and once for control.
Body composition was measured by DXA, providing measures of tissue, lean and fat mass at 1 week, 6 months and 1 year after diagnosis for patients and for the controls twice with one year in between.
All patients received intensive insulin therapy, health education about dealing with the disease and healthy diet.
The study revealed the following:
At diagnosis:
There were no significant differences between patients and controls as regard demographic and anthropometric parameters apart from non-significant lower value of body mass index, body mass index Z-score and fat mass in patients versus control. Patients showed significant higher basal HbA1c, hsCRP and lipid profile except HDL-C.
At 6 months:
Patients showed significant progressive increases in anthropometric parameters, tissue and fat masses.
After 1 year:
Patients showed significant increase in body mass index and body mass index Z-score, while significant decrease was occurred as regard HbA1c, hsCRP and lipid profile except HDL and LDL/HDL ratio than basal stage.
Patients showed non-significant higher values of tissue and fat components of body composition than control.
As regard the gender:
There was non-significant higher percent increase of tissue and fat masses in females versus males.
Males tended to have higher TG/HDL, TC/HDL, HbA1c, hsCRP percent decrease than females.
As regard the obesity:
The patients were classified into 2 groups according to BMI-Z score, obese (n: 7, 16%) and non-obese (n: 36, 84%).
There were no significant differences between obese and non- obese patients in age, Ht. Wt., WC. , WC/HC, SBP and DBP whereas obese patients showed significant increase in BMI and BMI-Z score. Obese patients showed non –significant increase in values of fat mass than non –obese.
Obese patients showed significant higher values of cholesterol, TG, and TG/HDL and tended to have higher LDL-C, Non-HDL-C, HbA1c and hsCRP.
Correlations:
No correlations between HbA1c and each of BMI, tissue, lean, fat masses at basal stage whereas there were significant positive correlations between HbA1c and each of BMI, tissue and fat masses after 1 year.
No correlations between HbA1c and lipid profile parameters whereas there was significant positive correlation between HbA1c and hsCRP after 1 year.
No correlations between hsCRP and each of Wt., BMI, BMI-Z, tissue, fat and lean masses in patients after 1 year.
No correlation between hsCRP and all parameters of lipid profile after 1 year.
Regression analysis:
Predictors of HbA1c after 1 year were fat mass and hsCRP.
from the current work, the study concluds that:
• Newly diagnosed T1D patients tended to have lower BMI and lower fat mass than their peers at diagnosis due to insulin deficiency.
• Then progressive increase in anthropometric parameters occurred after intensive insulin therapy which also caused improvement in glycemic control (HbA1c) and cardiovascular risk factors (lipid profile and hsCRP) after 6 months and 1 year of diagnosis.
• Males tended to have better improvement in insulin sensitivity (TG/HDL), glycemic control (HbA1c) and cardiovascular risk (hsCRP) than females; that could be explained by their regular physical activity and low fat content.
• Obese T1D patients tended to have poor glycemic control and they were more liable to dyslipidemia and cardiovascular risk.
• There was positive correlation between glycemic control and obesity with increased fat mass.
• Cardiovascular risk (hsCRP) was positively correlated with glycemic control.
• Thus, predictors of glycemic control (HbA1c) were fat mass and hsCRP.