Yeni Tanı Tip 1 Diyabetli Çocuklarda Korunmuş C-Peptid Düzeyleri: Vücut Kütle İndeksine Dayalı Bir Karşılaştırma

Öz

Amaç: Çocuklarda tip 1 diyabet (T1D) ve obezite prevalansındaki eşzamanlı artış, aşırı kilonun beta hücre fonksiyonu ve T1D'nin ortaya çıkışı üzerine etkilerine dair çelişkili raporlara yol açmıştır. Yeni tanı T1D’li çocuklardan oluşan geniş bir kohortta vücut kütle indeksi (VKİ) ile beta hücre fonksiyonu arasındaki ilişkiyi incelemeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya 1-18 yaş arası T1D tanılı 204 ardışık çocuk dahil edildi. Tıbbi verileri geriye dönük olarak inceledik. Korunmuş C-peptid düzeyi ≥0.6 ng/mL olarak tanımlandı. Değişkenlerin gruplar arası karşılaştırmaları uygun istatistiksel prosedürler kullanılarak yapıldı. Bulgular: Çocukların %18'i aşırı kilolu veya obezdi. Fazla kilo/obezite, tanı anında önemli ölçüde daha yüksek C-peptid seviyeleri ile ilişkiliydi [0.57 (0.05-2.99)'ye karşı 0.41 (0.05-2.58) ng/ml, p=0.01]. Hastaların %67'sinde C-peptid düzeylerinin korunduğu gözlendi.Korunmuş C-peptid düzeyi grubundaki hastalar tanı anında daha ileri yaştaydı [10.4 (1.9-16.5)'e karşı 7.5 (1.1-17.3) yıl, p<0.001], pubertal olma olasılıkları daha yüksekti (%61.2'ye karşı %22.6, p<0.001) ve daha yüksek VKİ SDS'e sahipti. (0.03±1.37 vs -0.67±1.47, p=0.001). Korunmuş C-peptid seviyelerine sahip olguların oranı, artan VKİ ile artmaktaydı ancak fark istatistiksel anlamlılığa ulaşmadı (%29.9 ila %45.9, p=0.06). VKİ SDS ile C-peptid seviyeleri arasında pozitif korelasyon varken (rs=0.24, p=0.001) HbA1c seviyeleri VKİ SDS ile negatif korelasyon gösterdi (r=-0.16, p=0.025). Sonuç: Fazla kilo/obezite, çalışma popülasyonunun önemli bir kısmında mevcuttu. Obez ve fazla kilolu çocuklar, T1D başlangıcında daha fazla rezidüel beta hücre fonksiyonuna sahipti. Bu çocukların beta hücre hasarının daha erken bir aşamasında tanı aldıkları söylenebilir.

Anahtar Kelimeler

• Tip 1 diyabet
• obezite
• fazla kilo
• C-peptid
• çocuk

Preservation of C-Peptide Levels in Children with New-Onset Type 1 Diabetes: A Comparison Based on Body Mass Index

Öz

Aim: The contemporaneous increase in type 1 diabetes (T1D) and obesity prevalence in children has led to conflicting reports regarding the effects of weight excess on beta-cell function and clinical manifestation of T1D. We aimed to analyze the association between body mass index (BMI) and beta-cell function in a large cohort of new-onset T1D youth. Material and Methods: This study included 204 consecutive children with T1D aged 1-18 years. We retrospectively reviewed the medical data. The preservation of C-peptide was defined as a C-peptide level ≥0.6 ng/mL. Comparisons of variables between groups were made using appropriate statistical procedures. Results: Eighteen percent of children were overweight or obese. Overweight/obesity was associated with significantly higher C-peptide levels at onset [0.57 (0.05-2.99) vs 0.41 (0.05-2.58) ng/ml, p=0.01]. Preservation of C-peptide levels was observed in 67% of patients. Patients with preserved C-peptide levels were older at onset [10.4 (1.9-16.5) vs 7.5 (1.1-17.3) yr, p<0.001], more likely to be pubertal (61.2% vs 22.6%, p<0.001) and had a higher BMI SDS (0.03±1.37 vs -0.67±1.47, p=0.001). The proportion of individuals with preserved C-peptide levels increased with increasing BMI, but the difference did not reach statistical significance (29.9% to 45.9%, p=0.06). While there was a positive correlation between BMI SDS and C-peptide levels (rs=0.24, p=0.001), HbA1c levels negatively correlated with BMI SDS (r=-0.16, p=0.025). Conclusion: Overweight/obesity was present in a significant proportion of the study population. Obese and overweight children had a greater residual beta-cell function at the onset of T1D. It could be speculated that they were diagnosed at an earlier phase of beta-cell damage.

Anahtar Kelimeler

• Type 1 diabetes
• Obesity
• Overweight
• C-peptide
• Children

Kaynakça

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