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Poster Session 1
other hand, SI in group A was significantly higher than those in three groups (p ~0.05) in MM, which might be expected by the HOMA-IR. Since FPIR in group D was not different from that in group A and significantly lower than those in groups B and C (p-=0.01), DI in group D was significantly lower than those in all other three groups (p
P795 Can PubBshed Norms Be Used To Assess the Prevalence of Obesity in Children with Diabetes? MANISHA WITMANS, Nadeem Jadavji, Jean-Francois Lemay, David Stephure, Danible Pacaud. Pediatrics, University of Calgary, Calgary, AB, Canada
Although weight gain is a complication of intensive diabetes management, the actual rate of obesity in children and adolescents with type 1 diabetes is not known in Canada. The objective of this study is to determine the prevalence of obesity in the diabetic population followed in our institution compared to published normative data. The data was collected using data of the last clinic visit from a chart review. Percentage of ideal body weight for height (PIBW) was calculated using the growth curves published by Hamill et al (AM J CLIN NUTR, 32607-29, 1979) and the standard deviation score for body mass index (SD-BMI) were calculated using the norms published by Rosner et al (J PEDIATR 132:211-22, 1998). Definitions of obesity used were a PIBW above 120% and a BMI above the 95th percentile for age and sex. The study population consisted of 348 children aged 6 to 16 yr. (mean age of 11.5 f 2.8 yr.). Fifty-six percent were males and mean duration of diabetes was 4.3 f 3.2 yr. Mean PIBW was 109 f 14% with a range of 66 to 162%. Mean SD-BMI was 0.17 f 0.7 with a range of -2.0 to 3.6. Using a BMl above 95th percentile as the standard, only 3.5% of our diabetic population is obese. This proportion increases to 16.9% when 120% of the PIBW is used as the standard. The prevalence of obesity is highly dependent upon the standard norms used to determine obesity. These findings suggest that using published normative dam cannot adequately establish the prevalence of obesity in this population. The relative risk of obesity in children and adolescents with type 1 diabetes can only be. determined using a normal control group as comparison.
P7% Development of ‘Qpe 1 Diabetes Despite Severe Hereditary B Lymphocyte Delkiency: No Pathogenic Role of B Lymphocytes STEPHAN MARTlN ’ , Dorothea Krtlger 2, Gaby Duinkerken 3, Werner A. Scherbaum’, Hubert Kolb’, Bart 0. Roep’. ‘German Diabetes Centre, German Diabetes Research Institute. Duesseldot$ Germany; 2 Children’+Hospital, Medical Centre, Minden. Germany: 3 Department of Immunohaematology and Blood Transfusion, Leiden Universiry Medical Centre, L.eiden, Netherlands Type 1 diabetes mellitus is caused by loss of insulin-secreting fi cells due to selective immune- mediated destruction by cellular immune reactivities. Recent results from animal models suggest an essential role of B lymphocytes during disease initiation and progression. Here we report on a first case of human type 1 diabetes in the virtual absence of B lymphocytes. A 14 year old boy with severe hereditary B
lymphocyte deficiency presented with hyperglycemia. The father and two brothers of the boy also exhibit B lymphocyte deficiency, but are non diabetic. At the age of 3 years B lymphocyte deficiency was diagnosed in the patient as evidenced by severely reduced immunoglobulin levels in serum and no detectable B lymphocytes in peripheral blood. ‘Iivo months before diabetes diagnosis transient glucosuria was observed. A subsequent infection of the middle ear was accompanied by hyperglycemia of more than 400 mg/dl. Insulin treatment was started and normal blood glucose values were obtained with a daily insulin dose of 40 IU. Basal and glucagon stimulated C-peptide were decreased indicating impaired insulin secretion capacity of pancreatic islets. Analysis of type 1 diabetes-specific autoantibodies (GAD, IA-2, ICA or IAA) showed negative results as expected for B lymphocyte deficiency. T-lymphocyte subsets in peripheral blood showed a relative increase in CD4+ T cells (66.4% CD4+, 16.5% CD8+, 16.9% CD4-/CD8-, 56.5% CD45RA+, 26.2% CDRAlRO+, 10.6% CD45RO+) while only 0.4% CD20+ lymphocytes were detectable. Genetic typing revealed HLA-DR3.4; DQ2,8 which is associated with the highest risk for developing autoimmune diabetes. Clear evidence for islet-reactive T cell autoimmunity was provided by the observation of strong proliferative and cytokine secretion responses to B cell antigens GAD65, IA-2 or 38kD antigen. No response was seen to human insulin. In summary, these findings offer for the first time direct evidence against an essential role of B lymphocytes in the pathogenesis of human type 1 diabetes, neither at the level of autoantibody production nor by acting as antigen presenting cells.
P797 Increasing Prevalence of ‘Qpe 2 Diabetes Mellitus in Children and Adolescents in Hungary ANNA KGRNER, Laszlo Madacsy, Tivadar Tulassay. 1st Dept. Pediatrics, Semmelweis University, Budapest, Hungary
According to the consensus statement recently released by the American Diabetes Association type 2 diabetes mellitus (DM) became an emerging epidemic in children. Moreover, people with type 2 DM often remain undiagnosed for several years and significant complications may be present already at diagnosis. The ahn of the study was to determine the prevalence of impaired glucose tolerance and type 2 DM at our diabetic Clinic. Methods: Diagnosis was based on oral glucose tolerance test according to criteria established by the US National Diabetes Data Group (1979) and the World Health Organisation (1985). In order to define the early signs of late complications ambulatory blood pressure monitoring and assessment of urinary albumin excretion have been performed. Results: Between January 1989 and September 1998 altogether 161 children with impaired glucose tolerance (mean age 10.8, range: 7-18 years) and 34 patients with type 2 DM (mean age: 11.9, range: 6-17 years) have been diagnosed at the 1st Department of Semmelweis University, Budapest, Hungary. There was a female predominance in both groups (M/F ratio in IGT group: 70/9 1, in DM group: 12/22). The majority of patients (IGT: 47 percent and type 2 DM: 24 percent) were overweight with serum triglyceride and cholesterin levels exceeding the age related normal values. Eighteen percent of patients with IGT and 32 percent of patients with type 2 DM had relative nocturnal hypertension. One third of patients with type 2 DM had an albumin excretion rate within the microalbuminuric range. Conclusions: IGT and type 2 diabetes mellitus are prevalent in the pediatric age group in Hungary. Sensitive methods can detect early signs of late complications already in children and adolescents with type 2 diabetes mellitus.
P798 Prevention of IDDM in Children with Prediabetes Using insulin ARTUR P. KUAE, Elzbieta Piontek, Joanna ChruSciel. Purpose of the study was prevention of IDDM in children with prediabetes using insulin. IDDM is closely related to cellular and humoral responses