engleski

Importance of gamma-glutamyl transferase in type 1 diabetes mellitus in children

Objectives and Study: Liver disorder associated with type 1 diabetes mellitus (DM1) in children might not be as rare as previously thought. We assessed number of simple and potentially reliable tests for its detection. Methods: Clinical examination, abdominal ultrasound (US) and liver enzymes were used to assess liver injury in a cohort of children with DM1. Those with elevated liver enzymes and abnormal US finding were additionally investigated. Laboratory tests that were performed twice within one year interval included aminotransferases (AST, ALT), gamma-glutamyl transpeptidase (GGT), glycosylated hemoglobin (HbA1c) and lipid panel. Patients were divided into four groups according to HbA1c values: well regulated (HbA1c ≤ 7.50 % on both occasions), deterioration after 12 months (first HbA1c ≤ 7.50 %, second >7.50 %), poorly regulated (HbA1c >7.50 % on both occasions), improvement after 12 months (first HbA1c >7.50 %, second ≤ 7.50 %). Results: Over the study period 154 children (77 male, 77 female) were examined, their age ranged between 2 to 20 years (mean 14.2± 3.1). DM1 duration ranged from 1 to 18 years (mean 7.7± 4.1). Mean HbA1c was 8.51±1.41% (min 5.6%, max 14.0%). There were 23 patients (14.9%) in the wellregulated group, 12 patients (7.8%) were in the group with deteriorated metabolic control during follow-up. In the group with improved metabolic control during follow-up, there were 10 patients (6.5%). Finally, there were 109 patients (70.8%) in the group with poor glycemic regulation. A total of 29 patients (18.8%) had elevated aminotransferases and/or GGT in at least one of the measurements. There was no statistical difference in AST and ALT values between the groups considering glycemic control. After one year significant rise of GGT values were observed (P = 0.031) in the group of poorly regulated patients (median HbA1c 12.0 %, range 10.0 -16.0%) and also in the group with deteriorated glycemic control (P=0.046). The most significant correlation in post hoc analysis (Mann Whitney U, P=0.009) was established between poorly regulated group and the group with improved control after 12 months (median HbA1c 9.0%, range 8.0-11.5%). Ultrasound revealed following abnormal findings: 33 patients (21.4%) had hepatomegaly, 42 patients (27.3%) had detectable changes in echogenicity (26 patients had hyperechogenic, and 16 hypoechogenic liver). There was no difference between glycemic control and US (hepatomegaly P=0.305, hyper or hypoechogenicity P=0.643). When hepatomegaly was compared with liver enzyme levels between the groups significant differences were observed for GGT levels. Normal values correlated with normal liver size, while increase in liver size correlated with increased GGT levels (P=0.010). Considering the ultrasound findings of hyper/hypoechogenicity, significant differences were noted for all liver enzymes: normal echogenicity was found in patients with normal aminotransferase and GGT levels, while increased liver enzymes levels correlated with changes in echogenicity (for AST P=0.002, for ALT P=0.027, for GGT P=0.001). Conclusion: GGT levels accurately reflect presence of liver disorder associated with poor metabolic control in DM1 patients. Abnormal US findings are significantly correlated with liver enzymes but not with glycemic control.

gamma-glutamyl transferase ; type 1 diabetes mellitus ; children

nije evidentirano