الفهرس 
Type 1 diabetes mellitus (T1DM)Only 14 pages are availabe for public view
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Abstract
Introduction:
Diabetes affects 1 in 10 persons in the United States and isprojected to increase to 1 in 3 adults by 2050. Diabetes is found in every population in the world and in all regions, including rural parts of low and middle-income countries. (Liset E M Elstgeest et al.,2018) .
Type 1 Diabetes Mellitus (T1DM) is a chronic disease that affects all aspects of patient’s life especially psychologically. The management of T1DM is complex, requiring a high degree of responsibility and self-control to achieve an adequate metabolic control. In fact, treatment guidelines recommend routine screening for emotional status and family relationships. On the other hand, hormonal and psychosocial changes that occur during puberty make this stage a difficult time with high metabolic instability, and many adolescents experience deterioration in metabolic control (marta et al, 2017).
Diabetes is one of the most common chronic diseases in childhood, with more than 18 000 new cases in youth below 20 yr. of age during 2008–2009. Diabetes is problematic in youth because associated microvascular changes may occur within 5 years. of diagnosis and decline in intelligence quotient may occur within 12 years .of diagnosis, possibly related to wide variations in glucose levels. (Folami Y Ideraabdullah et al.,2019)
Type 1 diabetes in adolescence has previously been linked to a range of psychosocial problems. In a review from 2009, Kakleas and colleagues concluded that Type 1 diabetes in adolescents was associated with increased risk of developing psychiatric disorders (10 – 20%), specifically eating disturbances (8–30%).(D. J. Korczak et al.,2011)
Neuropsychiatric disorders are multifactorial and are likely influenced by complex interactions between genetics, nutrition, and environment. There has been a considerable progress in the identification of gene variations associated with many neuropsychiatric disorders. (Line Wisting et al.,2018)
Deficiency of vitamin D is associated with various bone and non-bone health hazards. Among non-bone health hazards, in recent decades, growing evidence identified association of low serum vitamin D levels with neuro- degenerative disorders, poor cognition, attention deficit hyperactivity disorder, autism, depression and schizophrenia in adolescents and adults. (Jens Peter Hansen et al.,2019)
Aim of study:
To study the association between vitamin D level and psychiatric disorders in controlled diabetic children and adolescents.
Methods:
This is a Cross-sectional case control study was conducted on 80 child with Type 1 diabetes mellitus from both sexes, aged from 6 – 18 years old, who were attending the Diabetes Clinic, Children’s Hospital, Ain Shams University during a period of two years starting from May 2019 till June 2021( two days per week).
➢ Inclusion criteria:
• Cases diagnosed with controlled Type 1 diabetes mellitus.
• Age: children and adolescents
• Both sexes are included.
➢ Exclusion criteria:
• Any child with other chronic illness than diabetes mellitus.
• Cases with HbA1c >7% in the past 3 months.
• Any child whose parents refused to participate in the study.
.
children who enrolled in this study divided into 2 groups matched in age and sex, according to the presence of psychiatric disorders using child behavior checklist (CBCL) questionnaire into :
group 1: 40 controlled diabetic children and adolescents with psychiatric disorders.
group 2: 40 controlled diabetic children and adolescents without psychiatric disorders.
➢ Methods:
All patients were subjected to the following:-
I-History taking:
Personal and sociodemographic characteristics:
Laying stress on the sociodemographic data including: birth order, number of family members, crowding index, father’s education, father’s employment, mother’s education and mother’s employment.
Medical history of diabetes: For cases
• Age at onset of diabetes mellitus.
• Disease duration
• History of any supplementations eg. Calcium and any vitamins.
• Insulin therapy (type, dosage and number of insulin injections/day).
• History suggestive of acute diabetic complications:
o Hypoglycaemia (frequency, timing and severity).
o Diabetic ketoacidosis (frequency and precipitants).
o Number of hospital admission due to hypoglycaemia or diabetic ketoacidosis in the last 6 months prior to the study.
• History suggestive of microvascular diabetic complications (Retinopathy, peripheral neuropathy & nephropathy).
II-Examination:
Complete physical examination were done including:
1. Anthropometric measures (Weight in Kg, Height in Cm and Body mass index).
2. Pubertal assessment using Tanner staging (Tanner, 1988).
3. Chest, abdomen, cardiac examination.
4. Fundus examination if indicated.
5. Neurological examination (for assessment of diabetic neuropathy).
III- Neuropsychological test:
Child Behavior Checklist (CBCL),(Achenbach et al, 2001).
IV- Lab investigations:
Routine investigations for all cases:
• Random serum glucose level was checked.
• Serum level of HbA1c.
Biochemical investigation:
• serum 25 hydroxy-vitamin D level was estimated in both groups of diabetic children and adolescents.
Results:
There was statistically significant difference between the two groups in
1-age at onset of diabetes mellitus.
2-food rich in vit D
3-randum serum glucose level
4-serum level of 25 hydroxy-vitamin D.
Conclusion:
Vitamin D deficiency can predispose to psychiatric disorders in children and adolescents with type 1 DM
1. Conclusion
Vitamin D deficiency can predispose to psychiatric disorders in children & adolescents with Type 1D.M
2. Recommendations
Vitamin D supplementation to children and adolescents with Type 1 D.M can help in prevention and treatment of psychiatric disorders that they are liable.