الفهرس 
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Abstract
SUMMARY UMMARY UMMARY
ype 1 diabetes mellitus is caused by deficiency of insulin secretion due to pancreatic β-cell damage. It is the most common endocrine-metabolic disorder of childhood and adolescence and with increased and variable incidence. Abnormalities of the pancreatic exocrine compartment have been described in the past decades in both anatomy and function. It is unclear whether the exocrine changes in type 1DM are related to the same genetic, immunological, and environmental events resulting in beta cell destruction or are secondary to the loss of functional β cells.
This study aimed to validate the utility of serum trypsinogen and lipase as biomarkers of type 1 diabetes in newly diagnosed type 1 diabetic children and adolescents and correlation with pancreatic B cells function assessed by fasting C-peptide.
This cross sectional study was carried out on 50 newly diagnosed patients with type 1 diabetes; 29 males and 21 females with mean age of 7.37 ± 3.67 years (range, 2.5-16 years). They were compared to 50 age- and sex-matched healthy subjects served as controls.
Patients were excluded if having another type of diabetes such as MODY and type 2 DM.
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All the patients were subjected to: (i) detailed personal history with special emphasis on age of onset of diabetes, disease duration, diabetic ketoacidosis at presentation and symptoms suggesting pancreatitis (ii) thorough clinical examination laying stress on anthropometric measures (iii) Laboratory investigations including measurement of fasting lipid profile, mean HbA1c%, fasting C-peptide, serum trypsinogen and lipase.
Upon comparison of personal data between all patients and control subjects. It found that no significant difference was observed as regards age, sex, Consanguinity, Family history of DM between both groups (p>0.05).
Comparison between type 1 diabetic patients and control group revealed that patient group are underweight, low BMI and low Z score for weight and BMI (p<0.05),But no significant difference was found as regards height and height Z score (p>0.05).
Serum trypsinogen and lipase were significantly decreased in all type 1 diabetic patients compared to the control group (p<0.01) in both enzymes. There was no relation between serum trypsinogen and lipase and sex, age, duration of disease, weight, height, BMI, fasting C-peptide,HbA1c,lipid profile and insulin dose (p value> 0.05).
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Correlation studies showed significant positive correlations between HDL and age, weight and similar correlation between triglyercide and weight Z score. While total serum cholesterol was negatively correlated to fasting C-peptide but positively correlated to BMI Z score (p<0.05).
ROC curve analysis revealed that serum trypsinogen and lipase cut off value ≤ 40 ng/dl and ≤ 14.9u/l, respectively could differentiate people with and without type 1 diabetes with a sensitivity of 96.00% and 69.39% and specificity of 100.00%, respectively. The efficacy of trypsinogen and lipase were 98.9% and 90.1%, respectively.
Univariate logistic regression analysis revealed that highly statistically significant association found between type I diabetes patients and serum trypsinogen, serum lipase, weight, weight Z score, BMI and BMI Z score.
Multivariate logistic regression analysis revealed that serum trypsinogen level was independently related to type I diabetes (p-value = 0.002) than S lipase (p- value=0.065).