الفهرس 
Diabetes Mellitus in Children and AdolescentsOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both (Craig et al., 2014). Inadequate insulin secretion and/or diminished tissue responses to insulin in the complex pathways of hormone action result in deficient insulin action on target tissues, which leads to abnormalities of carbohydrate, fat, and protein metabolism. Impaired insulin secretion and/or action may coexist in the same patient (ADA, 2010). Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis (Modi et al., 2017)
Acute pancreatitis is a potentially lethal disease with varying widely in clinical features and severity which range from mild and self-limited to a rapidly progressive illness leading to multiple organ failure and death. The mortality rate ranges from 0% in the mild disease to 10% in sterile and 25% in infected pancreatic necrosis (Dervenis , 2016)
The aim of this study will be to evaluate the serum level of triglycerides and serum level of lipase as serological markers for acute pancreatitis in children with Diabetic Ketoacidosis (DKA).
Subjects & Methods:_
• Subjects:
This case controlled study was conducted on the patients attending to pediatric departments in Benha University Hospital and Benha Children Hospital from July 2017 to February 2018.
This work has been conducted in Clinical Pathology Department, Benha University Hospital.
All subjects were classified into 2 groups as following:
group (I) study group:
Included sixty type 1 diabetic children diagnosed by the following criteria :
Table (1):The diagnosis of type 1 diabetes mellitus based on criteria of American diabetes association:
Criteria for Diabetes Diagnosis
HbA1C≥6.5%*
Perform in lab using NGSP-certified method and standardized to DCCT assay
FPG ≥126 mg/dL(7.0 mmol/L)*
Fasting defined as no caloric intake for ≥8 hrs
2-hr PG ≥200 mg/dL (11.1 mmol/L) during OGTT (75-g)*
Performed as described by the WHO, using glucose load containing the equlivalent of 75g anhydrous glucose dissolved in water
Random PG ≥200 mg/dL (11.1 mmol/L)
In persons with symptoms of hyperglycemia or hyperglycemic crisis
*In the absence of unequivocal hyperglycemia results should be confirmed using repeat testing
*Unless clinical diagnosis is clear, same test to be repeated using a new blood sample for confirmation
( ADA, 2017)
HbA1c=Glycated hemoglobin;NGSP=national glycohemoglobin standardization program; DCCT=Diabetes Control and Complications Trial;FPG=fasting plasma glucose; PG=plasma glucose; OGTT=oral glucose tolerance test; WHO=World Health Organization
Inclusion criteria:
1. All of the diabetic patients receive insulin therapy during the investigation.
2. Males and females with the age range 4-15 years old.
Exclusion criteria:
1)Study group :
• The patients with malnutrition, liver disease and end stage renal disease.
• The patients with chronic illnesses such as gastrointestinal disorders, malabsorption and celiac disease.
2)Control group:
Healthy children who were on vitamin D, calcium supplementation, or multivitamins were excluded from control group.
group (II) control group:
Included twenty apparently healthy children age and gender matched to Diabetic patients group.
Ethical consideration: Approval of the study protocol by Ethical Scientific Committee of Benha University Hospital has been obtained and informed consent has been obtained from the parents before enrollment in the study.
The study group were under the following inclusion and exclusion criteria:
Methods:
All participants were subjected to the following:
1. Full history taking:
2. Thorough clinical examination
3. Laboratory Investigation including :-
• Random blood glucose.
• Serum triglycerides, HDL, LDL cholesterol.
• Aceton in urine.
• Glycosylated Hb (HbA1c).
• Serum lipase
Results:_
• There were 46% old DM and 54% new cases
• DKA showed significantly higher TC, LDL, significantly lower HDL when compared to control group.
• DKA group showed significantly higher TLC and significantly lower hemoglobin concentration when compared to control group. Platelet count did not differ significantly between both groups.
• TG was significantly higher in DKA group when compared to control group.
• DKA with AP showed significantly higher TC, LDL, and significantly lower HDL when compared to DKA without AP.
• TG and lipase levels were significantly higher in DKA with AP when compared to DKA without AP subgroups.
• ROC curve of TG and lipase was conducted for discrimination between non AP and AP in cases of DKA. TG and lipase showed excellent (AUC=0.967, 0.980; p<0.001, p<0.001 respectively) for discrimination between non AP and AP in cases of DKA.
• TG showed significant positive correlation with lipase, TC, LDL, HA1C and creatinine. Otherwise, no significant correlations were found between TG with other studied parameters in all studied cases.
• Lipase showed significant positive correlation with TG, TC, LDL, HA1C, creatinine, urea, platelets and K. Otherwise, no significant correlations were found between lipase with other studied parameters in all studied cases.
• TG showed significant positive correlation with BMI, TC, LDL in DKA with no AP subgroup; lipase, LDL in DKA with AP. Otherwise, no significant correlations were found between TG with other studied parameters in DKA with and without AP subgroups.
• Lipase showed significant positive correlation with platelets in DKA with no AP subgroup; TG in DKA with AP. Otherwise, no significant correlations were found between lipase with other studied parameters in DKA with and without AP subgroups.
• Regression analysis was conducted for prediction of AP within DKA children, using age, gender, DM type, HA1C, TG and lipase as covariates. Higher TG and lipase were associated with AP within DKA children in uni and multivariable analyses.