[The role of insulin secretion and insulin resistance in the clinical course of newly diagnosed diabetes mellitus in children].

BACKGROUND

The prevailing type of diabetes in Caucasian children and adolescents is type l. Insulin resistance resulting from decreased physical activity and obesity may account for the rising incidence of type l and type 2 diabetes mellitus in this group.

AIM

To estimate the role of insulin secretion and insulin resistance in the clinical course of new onset type l diabetes mellitus in children and adolescents.

MATERIALS AND METHODS

58 patients aged 7.6-17.9 years, underwent investigations within the first 7 days after diabetes mellitus diagnosis. In 56 individuals type l and in 2 - type 2, was diagnosed. Insulin secretion was estimated by measurement of the serum C-peptide concentration in glucagon test while the Euglycemic-hyperinsulinemic clamp was performed to assess insulin resistance. HbA1c, glycemia and pH were examined. Body mass index (BMI) and the required daily dose of insulin (DDI) were calculated.

RESULTS

In patients with diabetes C-peptide level was 0.03-1.5 pmol/ml. Index M ranged from 1.5 to 13.09 mg/kg/min. The hyperbolic relation was observed between C-peptide level and index M (r=0.62). There was a positive correlation between age at diabetes onset and C-peptide level (r=0.25) and negative with index M (r=-0.59). C-peptide level and index M correlated with body mass index (r=0.58; r=0.59; respectively). A relationship between glycemia and C-peptide level (r=-0.42) and index M (r=0.26) was found. Correlation between HbA1c and C-peptide level (r=-0,42; p=0.001) and index M (r=0.3) was observed. Dose of insulin correlated with C-peptide level (r=-0,2).

CONCLUSIONS

In children with newly diagnosed diabetes mellitus a great variability of insulin secretion and insulin resistance was observed and a hyberbolic function between them. There was a relationship between insulin secretion and insulin resistance with age at onset and obesity. C-peptide level mainly determined HbA1c, glycaemia, pH and the needed dose of insulin.