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Carbohydrate metabolism and capillary basement-membrane thickness in children. I. cross-sectional studies
Insights
Children with diabetes show impaired glucose metabolism and increased basement membrane thickness. These changes, particularly basement membrane thickness, may indicate early diabetic complications in pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Vascular Complications
Background:
- Childhood diabetes mellitus is a growing concern with potential long-term complications.
- Understanding early markers of metabolic dysfunction and vascular changes is crucial for pediatric diabetes management.
Purpose of the Study:
- To investigate glucose metabolism, insulin response, and basement membrane thickness in children with and without diabetes.
- To explore correlations between these parameters and their potential as early indicators of diabetic complications.
Main Methods:
- Intravenous glucose tolerance tests (IVGTTs) were performed to assess glucose disappearance rates (K) and plasma insulin responses.
- Fasting plasma growth hormone (GH) levels were measured.
- Basement membrane thickness (BMT), including average (ABMT) and minimum (MBMT), was analyzed from quadriceps femoris muscle biopsies.
Main Results:
- Diabetics and suspected diabetics exhibited significantly lower glucose disappearance rates (K) compared to controls.
- Plasma insulin responses varied, with diabetics showing the smallest and suspected diabetics the greatest responses.
- While not statistically significant, diabetics and suspected diabetics had increased mean ABMT and MBMT, with a higher prevalence of high BMT values compared to controls. Correlations between BMT and glucose tolerance (K) were generally negative.
Conclusions:
- Children with diabetes, even those suspected, display impaired glucose tolerance and a tendency towards increased basement membrane thickness.
- Basement membrane thickness may serve as an early indicator of microvascular changes in pediatric diabetes.
- Further longitudinal studies are warranted to confirm the relationship between BMT and glucose tolerance progression in children.
Abstract:
Thirty-nine children from three to 16 years of age were included in this study. Nineteen were diabetics, seven were "suspected" diabetics (with evidence of glucose intolerance but without repeated fasting hyperglycemia), and 13 were controls. Mean glucose disappearance rates (K) during intravenous glucose tolerance tests (IVGTTs) were 2.19 for the controls, 1.23 for the suspected diabetics, and 0.70 for 14 diabetics tested; the differences were statistically significant. Diabetics had the smallest and suspected diabetics the greatest plasma insulin responses during IVGTTs. Fasting plasma growth hormone (GH) varied widely. GH generally decreased or remained unchanged during IVGTTs, but two diabetics exhibited slight increases and two sustpected diabetics pronounced increases. Basement-membrane thickness (BMT) was examined in 42 quadriceps femoris needle biopsies. Average BMT (ABMT) and minimum BMT (MBMT) correlated well (r = 0.91). BMT did not correlate well with age or, in the diabetics, with duration of clinical disease. Diabetics had the greatest and controls the least mean ABMT and MBMT, but the differences were not statistically significant. High values (those exceeding mean control values by more than two standard deviations) were much more common among the suspected diabetics and the diabetics. One of 13 controls, three of six suspected diabetics, and six of 19 diabetics had high ABMT values; two suspected diabetics and five diabetics had high MBMT values. Correlations between BMT and K were negative for the most part, but correlation coefficients were small. Serial studies in four of the children suggest that BMT and glucose tolerance tend to change in opposite directions.