الفهرس 
Aim of The StudyOnly 14 pages are availabe for public view
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Abstract
diabetes mellitus ‘DM’ has been defined as being a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of DM include long term damage, dysfunction, and failure of various organs. Diagnosis is made by the presence of classic symptoms of hyperglycemia and an abnormal blood test, a plasma glucose concentration ≥ 7 mmol/l (or 126 mg/dl) or ≥ 11.1 mmol/l (or 200 mg/dl) two-hours after a 75 g glucose drink (ADA, 2017).
When using glycosylated hemoglobin (HbA1C) to diagnose DM, it is important to recognize that HBA1C is an indirect measure of average blood glucose levels and to take other factors into consideration that may impact hemoglobin glycation independently of glycemia including age, race/ethnicity, and anemia/ hemoglobinopathies (Nowicka et al, 2011).
T1DM usually develops during childhood and adolescence and patients require lifelong insulin injections for survival, it is one of the most common endocrine and metabolic conditions in childhood. Data from large epidemiological studies worldwide indicate that on an annual basis, the overall increase in the incidence of T1DM is around 3% and about 78,000 children under age 15 years develop T1DM worldwide (IDF, 2013).
The wide variation in incidence can hardly be explained by genetic factors alone. Environmental factors have long been implicated in the pathogenesis of T1DM both as initiator and potentiators of pancreatic β-cells destruction (Knip and Simell, 2012).
Among Eastern Mediterranean and Middle Eastern countries, the largest contribution to the total number of estimated childhood T1DM cases comes from Egypt which accounts for about a quarter of the region’s total. The incidence has been estimated as 8/100 000 per year (Egypt) in children under the age of 15 years (Soltèsz, et al, 2006). While in Nile delta, the calculated age-adjusted incidence of T1DM in 2011 was 3.1 in 100,000/year, whereas the calculated age-adjusted prevalence of T1DM in the same year was 26.8 in 100,000/year (El-Ziny et al, 2014).
Vitamin D is a multi-functional fat-solute metabolite required for human growth and health. The primary source of vitamin D in (80–90%) is from endogenous biosynthesis in skin cells during sun exposure (Holick, 2008).
Vitamin D appears to have a role in innate immunity is postulated, and deficiency can lead to susceptibility to infectious diseases, and autoimmune conditions, such as type 1 diabetes. Vitamin D and its metabolites appear to have important effects on insulin synthesis, secretion and action, as well as components of inflammation (Gandhi et al, 2015).
The aim of the study was to assess the environmental risk factors (represented in vitamin D), contributing in the pathogenesis of T1D, and to study the effect of oral vitamin D supplementation on blood glucose levels, also to assess the validity of vitamin D as biomarker for follow up for T1D patients compared to HbA1c..
The study included 45 children and adolescents with type 1 diabetes. The patients were attending the Pediatric and Adolescents Diabetes Clinic of Children’s Hospital, Ain Shams University, Egypt, over 7 months period from September 2019 to March 2020.
UVI was recorded throughout the period of the study (September 2019 till end of March 2020)
All participants were subjected to 1- initial assessment: detailed history taking, full clinical examination, and laboratory assessments serum 25-OH Vitamin D3 and Hemoglobin A1C (HbA1c) 2- oral vitamin D supplementation was given to all patients for 3 months 3-Follow-up assessment after vitamin D supplementation (history and lab) were done after 3 months from the initial assessment.
The study showed that serum vitamin D was deficient among Egyptian children and adolescents with T1D. and although the levels of HbA1c was higher than those recommended levels (for being controlled) yet such levels showed marked and statistically significant improvement after vitamin D oral supplementations for 3 months.
It is also worth notice that there were no significant statistical difference as regard either the sex (males or females) or the age (<12 yrs or ≥12 yrs) in serum vitamin D levels at the initiation of the study or post oral VD intake.
Our study also concluded that serum vitamin D level could be used as a reliable tool for following up T1D patients.
Finally documenting the UV-index daily at different daytime hours for 7 months (from September till end of March), it appears that least readings were at 8am and 4pm and the highest were at 12pm. Whereas UVI was lowest in December and Highest in September.