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العنوان
Relation of Serum Insulin Like Growth Factor- 1 With Cognitive Performance in Type 1 Diabetic Children /
المؤلف
Abu Zeid, Dina Ahmed El Sayed Ahmed.
هيئة الاعداد
باحث / Dina Ahmed El Sayed Ahmed Abu Zeid
مشرف / Mona Hussein El Samahy
مشرف / Rehab Abd El Kader Mahmoud
مناقش / AblaGalal Khalifa
مناقش / Amira Abd El Monem Adly
تاريخ النشر
2014.
عدد الصفحات
197 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الطب (متفرقات)
تاريخ الإجازة
1/1/2014
مكان الإجازة
جامعة عين شمس - معهد الطفولة - Medical Studies
الفهرس
Only 14 pages are availabe for public view

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from 197

Abstract

Type 1 diabetes mellitus (T1DM) is the most commonly diagnosed type of DM in children and adolescents. It presents usually with symptomatic hyperglycemia and imparts the immediate need for exogenous insulin replacement.The presentation of T1DM is either as classic new onset (most common)which is characterized with polyuria, polydipsia, polyphagia and lethargy, silentT1DM which typical lydiagnosed by families or physicians with high index of suspicionor DKA which presents with dehydration, vomiting, altered mental status and rapid deep respiration (Kussmaul’sbreathing).T1DMleads to alterations in the growth hormone–insulin-like growth factor -1 (GH–IGF-1) axis.T1DM resulted in impairment of cognitive functions as visual motor development, visual spatial memory, visual organization, visual perception, short term memory, concentration and selective attention.
Our aim in this study was to investigate the relation between serum IGF-1 and cognitive performance in children with type 1 diabetes mellitus.
This case control study included 40 children, with type 1 diabetes mellitus recruited from the regular attendants of the Diabetes Clinic, Children’s Hospital, Ain Shams University during a full calendar year, they were 18 males and 22 females, their ages ranged from 6 to 10 years.
Inclusion criteria:
• Cases diagnosed with Type 1 diabetes mellitus.
• Prepubescent (not more than Tanner stage 1).
Exclusion criteria:
• Cases diagnosed with Type 1 diabetes mellitus and associated with another chronic disease that may affect cognitive performance as chronic renal failure, cardiac diseases and genetic disorders.
• Cases proved to be mentally retarded.
• Cases with auditory impairment.
• Cases with visual impairment.
They were classified into two groups:
Group І:20 patients with type 1 diabetes with HbA1c < 8%(10 males; 10 females) with ages ranging from 6 to 10 years.
Group П:20patients with type 1 diabetes with HbA1c ≥
8%(8 males; 12 females) with ages ranging from 6 to 10 years.
Our study also included 40 apparently healthy children of the same social background recruited from the outpatient clinic, Children’s Hospital, Ain Shams University. They were 21 males and 19 females, their ages ranged from 6 to 10 years.
An oral consent was obtained from each subject in the study and written informed consent from their parents after explanation for the aim of the study.
Each child (patients& controls) was subjected to:
1. Full medical history: Laying stress on the sociodemographic data. For patients: age of onset, duration of the disease and regimen of treatment.
2. Thorough clinical examination: With particular emphasis on full neurological examination, puberty assessment according to Tanner stages and fundus examination.
3. Auxological Assessment: through measurements of weight and height.
4. Dietary Intake: The 24-hours recall method was used.
5. Assessment of cognitive performance: Cognitive function was assessed by a battery of psychological tests which were:
a) The Arabic version of the Revised Wechsler Intelligence Scale for Children (WISC-R).
b) The auditory vigilance test.
c) The figural memory test.
6. Psychosocial Assessment: The Pediatric Symptom Checklist- 17 (PSC-17) was filled out by the child’s caregiver.
7. Laboratory Investigations:
Routine investigations :( for patients)
• Random blood sugar.
• Glycosylated hemoglobin (HbA1C).
• Urinary micro albumin.
Biochemical Analysis: (for patients and control)
• Growth hormone.
• Insulin like growth factor 1 (IGF-1).
• Insulin like growth factor binding protein 3 (IGFPB-3).
Our study revealed the following:
- Significant increase in weight and in weight for age Z score and highly significant increase in body mass index and Z score of body mass index in patients than controls.
- No statistically significant difference between patients and controls in height and height for age Z score.
- Highly significant increase in GH of patients more than that of controls and significant increase in IGF-1 of patients more than that of controls while there was no statistically significant difference between patients and controls inIGFBP-3.
- There was statistically significant difference between patients and controls as regards information scaled score, picture completion score and coding scaled score and there was statistically highly significant difference between them as regards digit span scaled score, similarities scaled score, block design scaled score, total scaled verbal score, total scaled performance score, verbal IQ, performance IQ and total IQ. All Scores of our patients were lower than controls.
- Auditory vigilance test when measured in patients and controls showed that there was statistically highly significant difference between them. Type 1 diabetic patients did more mistakes than controls.
- Statistically significant difference between patients and controls as regards figural memory test being lower in patients.
- Pediatric Symptom Checklist 17 when measured in patients and controls showed that there was statistically significant difference between them as regards internalizing score. Patients had higher values than controls. While there was no significant difference between them in externalizing score, attention and total score.
- There was highly significant increase in zinc intake in patients than in controls and significant increase in the percentage of RDA of zinc in patients than in controls.
- There was highly significant difference between group I (HbA1c < 8%) and group II (HbA1c ≥ 8%)in disease duration and number of hypoglycemic attacks.
- No significant difference between group I and group II as regards psychological tests and psychosocial assessment.
- We demonstrated a positive significant correlation between HbA1c and internalizing score.
- No significant correlation between GH, IGF1, IGFBP3 and psychological tests.