| Background: Type-1 diabetes mellitus(T1DM) is the commonest
endocrine-metabolic disease in childhood. Ghrelin is a 28-amino-acid
peptide hormone secreted predominantly by P/D1 cells lining the fundus
of the stomach and epsilon cells of the pancreas that stimulates appetite
with lesser amounts secreted by other cells. It is not clear which factors
are involved in the regulation of ghrelin secretion in children with
T1DM. Objective: This study aimed to estimate the level of pre-prandial
plasma ghrelin level in children with T1DM and to clarify the
relationship between its level and some parameters that may affect it as
BMI, serum glucose and HbA1C levels and the effect of insulin therapy
on its level. Methods: This study included 88 children, 66 diabetic
children with type-1 diabetes mellitus(22 new-onset diagnosed diabetic
children, 22 good glycemic controlled diabetic children on regular
insulin therapy and 22 poor glycemic controlled diabetic children on
insulin therapy) and 22 healthy controls. Diabetic children selected
from the Diabetic Clinic and Inpatient Pediatric department, Minia
University hospital from April 2009 to March 2010. Their ages ranged
from 4 to 10 years with a mean 8.5 ± 1.53 years. All children were
subjected to history taking, clinical examination, anthropometric
measurements and laboratory investigations included: Fasting and two
hours post-prandial blood glucose, HbA1C , liver and renal function
tests and pre-prandial plasma ghrelin level using enzyme linked
immunosorbant assay (ELISA). Results: Pre-prandial plasma ghrelin
levels were significantly higher in diabetic children than
controls(24.4±21.4 & 9.8±3.6 pg/ml respectively, p value=0.002).Both
new-onset and poorly controlled diabetic groups were significantly
higher in plasma ghrelin levels (37.03±24.2 & 25.1±19.5 pg/ml, p
value=0.001 & 0.001 respectively),but no significant difference between
good glycemic controlled diabetic group and controls(11.09±9.6 &
9.8±3.6 pg/ml respectively, p value=0.5). Significant negative
correlations were found between ghrelin level and weight , weight on
centile, BMI and BMI on centile, ,fasting and 2 hours post prandial
glucose levels in all diabetic children. No significant difference between
males and females as regards ghrelin level was present. Conclusions:
Children with T1DM had significantly higher levels of pre-prandial
plasma ghrelin level. Its level increased in both of new-onset and
poorly controlled diabetic children. Significant negative correlations
between pre-prandial ghrelin level and weight, BMI, fasting and 2-
hours post-prandial levels were present. Insulin therapy plays an
important role in normalizing plasma ghrelin level in good glycemic
controlled T1DM children. No significant correlation between ghrelin
and HbA1C was present. |