Glucose fluctuations in association with oxidative stress among children with T1DM: comparison of different phases
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Xi Meng1, Chunxiu Gong, Bingyan Cao
1Department of Endocrinology, Genetics, and Metabolism (X.M., C.G., B.C., D.W., Y.G., L.W., X.L., M.L., W.L., C.S.), Ministry of Education National Key Discipline of Pediatrics (X.M., C.G., B.C., D.W., Y.G., L.W., X.L., M.L., W.L., C.S.), and Center of Clinical Epidemiology and Evidenced Based Medicine (X.P.), Beijing Children's Hospital, Capital Medical University, Beijing 100045, P.R. China.
Insights
Glucose fluctuations are linked to increased oxidative stress in children with type 1 diabetes mellitus (T1DM). This association was observed across all disease phases, suggesting fluctuations may impact oxidative stress more than sustained high blood glucose.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Oxidative Stress Research
Background:
- Previous research on glucose fluctuations and oxidative stress primarily involved adults with type 2 diabetes.
- Limited data exists on this association in pediatric populations, particularly those with type 1 diabetes mellitus (T1DM).
Purpose of the Study:
- To investigate the relationship between glucose fluctuation parameters (GFPs) and oxidative stress markers in children with T1DM.
- To examine this association across different clinical phases of T1DM in children.
Main Methods:
- A case-control study was conducted at Beijing Children's Hospital.
- Children with T1DM were categorized into three groups: acute metabolic disturbance, honeymoon phase, and long-standing phase. Healthy controls were age- and sex-matched.
- Oxidative stress was assessed using the 24-hour urinary 8-iso-prostaglandin F2α to creatinine (8-iso-PGF2α/Cr) ratio. GFPs included measures of glucose variability.
Main Results:
- Children with T1DM exhibited significantly higher 8-iso-PGF2α/Cr and GFPs compared to healthy controls across all T1DM phases.
- A significant positive correlation was found between the 8-iso-PGF2α/Cr ratio and all GFPs in all T1DM groups.
- Mean amplitude of glucose excursions showed a stronger association with oxidative stress than glycated hemoglobin in acute and long-standing T1DM phases.
Conclusions:
- Glucose fluctuations are positively associated with oxidative stress in children with T1DM, irrespective of the disease phase.
- The findings suggest that glucose fluctuations might play a more significant role in inducing oxidative stress than chronic hyperglycemia alone in T1DM.
- Coexisting high blood glucose levels may be necessary for these effects to manifest fully.
Context:
Previous studies on the association between glucose fluctuations and oxidative stress in diabetes mellitus were all conducted in adults, and most study participants had type 2 diabetes mellitus.
Objective:
The study objective was to examine the association of glucose fluctuation and oxidative stress in children with type 1 diabetes mellitus (T1DM) across different phases.
Design:
This was a case-control study.
Setting:
The setting was the Beijing Children's Hospital (2010-2013).
Patients:
Children treated for T1DM were divided into three study groups, including group A (newly diagnosed cases in the acute metabolic disturbance phase), group B (the honeymoon phase), and group C (the long-standing phase). Healthy control children were matched to the T1DM patients by age and sex.
Interventions:
There were no interventions.
Main Outcome Measures:
The 24-hour urinary free 8-iso-prostaglandin F2α to creatinine (8-iso-PGF2α/Cr) ratio indicated oxidative stress. Glucose fluctuation parameters (GFPs) included mean blood glucose levels, standard deviation of daily blood glucose levels, mean amplitude of glucose excursions, and incremental area under the curve for postprandial glucose.
Results:
In each study group, 8-iso-PGF2α/Cr and all GFPs in children with T1DM were significantly higher than those in normal controls. 8-iso-PGF2α/Cr was significantly correlated with all GFPs in all three T1DM groups. A stronger association with 8-iso-PGF2α/Cr for mean amplitude of glucose excursions than for glycated hemoglobin was observed in both the acute metabolic disturbance and long-standing phases of T1DM.
Conclusions:
Glucose fluctuations were positively associated with oxidative stress in T1DM patients in different phases. Glucose fluctuations may have a stronger effect than sustained chronic hyperglycemia on triggering oxidative stress, but coexisting high levels of blood glucose may be required.
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