Postprandial hyperglycemia in the prevention of vascular complications in children with type 1 diabetes mellitus

The main sign of diabetes mellitus is a chronic hyperglycemia and lipid metabolism abnor-mality. Diabetes mellitus is a risk factor for of cardiovascular complications caused by diabetes mellitus as well. The information concerning these disorders in type 1 diabetes mellitus, particularly in children, is inconsiderable in number and is contradictory.

The purpose of the research is to study the state of fat exchange and the possibility of its cor-rection in children with type 1 diabetes mellitus.

The author observed 61 children and adolescents of the age of 3 to 17 with the same type 1 diabetes mellitus, but with different duration of the disease. The duration of observation lasted for 12 weeks. All the patients and their parents were trained to plan a diet. Special attention was paid to food containing a large amount of dietary fibers. Monitoring the adequacy of the ongoing insulin therapy was carried out by assessing the status and well-being of patients, as well as the determination of glycemia at seven time points. The content of VLDL, LDL, HDL, VLDC, LDC, HDC, Chol, SHC, and NEFA in serum was de-termined in the dynamics. The results of the study showed that prescription of ultra-short insulin preparations to children with type 1 diabetes mellitus contributed to a significant improvement of metabolism, which demonstrated not only a reduction in glycemia level, but also favourable changes in a blood lipid profile.

Background. As is known, the main sign of diabetes mellitus (DM) is a chronic hyperglyce-mia. Diabetes mellitus is a risk factor for of cardiovascular complications caused by diabetes mellitus as well [1]. For the formation of the latter, in addition to hypergly-cemia, lipid metabolism abnormality is of central importance. [1,2]. In the references there is a lot of data on changes in lipid metabolism in type 2 DM [1,3]. The information concerning these disorders in type 1 diabetes mellitus, particularly in children, is inconsiderable in number and is contradictory [4].

Purpose of the study. The purpose of the research is to study the state of fat exchange and the possibil-ity of its correction in children with type 1 diabetes mellitus.

Material and methods. We have observed 61 children and adolescents of the age of 3 to 17 with the same type 1 diabetes mellitus, but with different duration of the disease. All the children received an intensified insulin therapy (IIT) prior to the study. The average daily dose of insulin was 0.75 Ã 0.25 unit/ kg. All the patients and their parents were trained to plan a diet. Special attention was paid to food containing a large amount of dietary fibers, as sources of carbohy-drates; however, refined carbohydrates were excluded from the diet.

Monitoring the adequacy of the ongoing insulin therapy was carried out by as-sessing the status and well-being of patients, as well as the determination of glycemia at seven time points: before all meals, after 2 hours after the meals, and at 3 o'clock in the morning.

In addition, the content of VLDL, LDL, HDL, VLDC, LDC, HDC, Chol, SHC, and NEFA in serum was determined in the dynamics (at the beginning and at the end of the study). The duration of observation lasted for 12 weeks. The coefficient of atherogenics (CA) was calculated according to the formula: CA = (Chol-HDC) /LDC. For evaluation of the effectiveness of the conducted therapy some criteria of com-pensation for diabetes mellitus in children, recommended by the St Vincent Declaration, [5] were used. According to the Declaration a terminal therapy objective for children with type 1 diabetes is to achieve glycemia on the empty stomach of at least 7.0 mmol /l, and less than 10 mmol /l after 2 hours after a meal.

Table 1 - Dynamics of glycemia levels in children with type 1 diabetes mellitus, treated with ultra-short acting insulin

 

before breakfast

after 2 hours after a meal

before dinner

after 2 hours after a meal

before supper

after 2 hours after a meal

at 3a.m

Before the prescription of ultrashort act-ing insulin

11.08Ã2.1

11.02±2.04

9.60±1.25

13.19±1.80

11.41±0.91

10.68±0.75

10.92±1.12

After a month

7.30Ã0.08

8.61±L13

6.50±1.59

6.40±0.90

8.20±1.00

8.15±0.84

5.47±0.51

Р1

>0.05

>0.05

>0.05

<0.05

>0.05

>0.05

<0.05

After 2 months

7.91±L06

6.70±0.83

5.72±0.54

6.80±0.35

4.70±0.34

5.40±0.35

 

Р2

>0.05

>0.05

<0.05

<0.05

<0.05

<0.05

 

After 3 months

7.10±1.09

8.30±1.02

3.51±0.28

4.70±0.31

4.72±0.38

4.72±0.40

5.41±0.32

Р3

>0.05

>0.05

<0.01

<0.05

<0.05

<0.05

<0.05

Note:

Р1 - reliability of differences in glycemia figures in a month by contrast with the input data; Р2 - reliability of differences in glycemia figures in 2 months by contrast with the input data;

Р3 - reliability of differences in glycemia figures in 3 months by contrast with the input data;

Table 2 - Dynamics of lipid exchange in children with type 1 diabetes mellitus, treated with ultra-short acting insulin

Results and Discussion. As it is shown in Table 1, in advance of taking the ultra-short preparations of insulin the glycemia levels before meals matched with decompensation of diabetes mellitus. Levels of glycemia after 2 hours after breakfast and supper were quite acceptable, and only after 2 hours after dinner the content of glucose in the blood exceeded a tolerance level up to 3.20 mmol/l. 3 months of transfer to ultra-insulin preparations resulted in a decrease in glycemia level after breakfast to 8.0 mmol/l and to its normal level after 2 hours after dinner and supper. Due to simultaneous measurement of an insulin dose the prolonged normoglycemia at night and a quite reasonable average number of glucose blood levels on an empty stomach were achieved.

The improvement of carbohydrate metabolism was accompanied by a signifi-cant decrease in blood atherogenic lipid fractions (Table 2). Thus, the level of VLDL was decreased by 2.3, LDL by 1.3, LDC by 1.9, NEFA by 1.8 times. The Level of HDC (P <0.05) was significantly increased. There was a trend to decrease in CA.

Conclusions.

  1. Improvement of metabolic processes in the prescription of ultra-short insu-lin preparations demonstrates not only a reduction in glycemia level, but also fa-vourable changes in a blood lipid profile.
  2. Prescription of ultra-short insulin preparations to children with type 1 dia-betes mellitus contributes to a significant improvement of metabolism.

Indicators

Input values

After 3 months Oftreatment

P

Changes in indicators, %

VLDL1 mg/dl

600.58±84.20

290.20±93.64

<0.01

54.1

LDL1 mg/dl

691.74±69.29

5l·2.41±42.10

<0.05

35.2

HDL1 mg/dl

138.70±12.76

154.38±23.65

<0.05

12.5

VLDC1 mmol/1

0.23±0.08

0.13±0.05

<0.05

77.1

LDC1 mm□ỉ/1

2.11±0.29

1.95±0.14

<0.05

6.7

HDC1 mmol/1

0.87±0.12

1.20±0.10

<0.05

30.1

Chol1 mmol/1

3.19±0.22

3.26±0.15

<0.05

0.8

SHC1 mmol/1

0.86±0.31

0.53±0.12

<0.05

61.7

NEFA1 mmol/ỉ

1.08±0.20

0.65±0.09

<0.01

68.9

CA

3.90±0.71

2.92±0.57

<0.05

33.1

 

REFERENCE

  1. S.G. Kozlov, A.A. Lyakishev, Treatment of ischemic heart disease in pa-tients with type 2 diabetes. RMJ (11). 2003. - №9. - Р.53-56.
  2. Y.A. Chernyshev, L.A. Krivtsov, Dyslipidemia in the genesis of diabetic heart disease in children. Second Russian Congress of Diabetes: "Diabetes melli-tus and cardiovascular complications" Abstracts. M.: 2002. – Р. 282-283.
  3. V.A. Aliyev, Features of lipid metabolism in patients with diabetes melli-tus. Second Russian Congress of Diabetes: "Diabetes and cardiovascular compli-cations." Abstracts. M.:. 2002. - 90 р.
  4. L.L. Vakhrusheva, Y. Knyazev, T. Turkin, Dyslipidemia in diabetes melli-tus in children and their correction. Second Russian Congress of Diabetes: "Dia-betes and cardiovascular complications." Abstracts. M.: - 2002. – 264 р.
  5. S. Franc, D.K. Van, B.L. Joost St Vincent Declaration and its importance in general practice. Diabetography. 1998. - Р. 7-10.
Year: 2015
City: Almaty
Category: Medicine
loading...