| Backgrounds:Human health is faced with the threat of non communicable diseases,in which diabetes and complications are one of the most ruthless killers.Type 1 diabetes mellitus(T1DM)is a metabolic disease characterized by autoimmune mediated selective insulin damage and glucose metabolism disorder.TIDM is one of the most common chronic diseases in children.Diabetic complications including diabetic ketoacidosis,hyperosmolar coma,cardiovascular disease(cardiovascular disease CVD)(hypertension,cerebrovascular disease,heart disease),diabetic eye disease(blurred vision,blindness),diabetic foot disease(foot gangrene and amputation),diabetic nephropathy(kidney failure,uremia),gastrointestinal diseases,diabetes,oral skin disease,diabetic neuropathy,is a major cause of death in diabetic patients.Children with type 1 diabetes have the characteristics of small age,long course of disease,poor compliance and uncontrollable blood sugar.If there is no comprehensive systematic management,there may be serious consequences such as intelligence impairment,growth retardation,even diabetes dwarfism,blindness,kidney failure and so on.Even advanced western countries,HbA1C is also difficult to meet the ISPAD standard of good blood glucose control.In the United States,in 2007,174 billion dollars were used for treatment of diabetic patients,of which $58 billion was used for treatment of diabetic complications.There are few patients with type 1 diabetes over 30 years in China.The average age of patients with type 1 diabetes in the US is 67,5 years,with an average course of 56.5 years,suggesting that the survival time of Chinese patients with type 1 diabetes is severely impaired.In view of the characteristics of long duration,huge cost,multiple complications and huge risk of death in children,it is of great significance to explore the clinical characteristics and serum metabonomics of type 1 T1DM,explore the comprehensive management experience and screen early markers of complications.Objective:To analyze the clinical characteristics of type 1 diabetes in children and adolescents,to understand the comprehensive management effect of type 1 diabetes in our center;to explore the changes of serum metabolomics in type 1 diabetes of children and adolescents with different disease course by using serum metabolomics technology.Methods:First of all,by using software developed by our department of prevention and control design of children with type 1 diabetes,all patients were clinical feature data:gender,age,disease duration,insulin therapy,duration of hypoglycemia and ketoacidosis occurrence,glycosylated hemoglobin,diabetes antibody,biochemical data,fundus examination results.Second,a total of 76 children with type 1 diabetes were randomly selected to detect endogenous small molecule metabolites by untargeted metabolic profiling platform,TM(Xplore MET,Metabo-profile).Results:(1)Among 311 children with type 1 diabetes,147 males and 164 females,the ratio of male to female was 0.9:1(X2=1.86,p=0.173),the age of onset was 9.2 years old in male,9.0 years old in female;among them,the number of cases was the highest among 5-10 years old,accounting for 43.4%(135/3 11)(x2=10.8,p=0.002).(2)The duration of 311 children with type 1 diabetes was(2.2±2.2)years,130 patients had DKA,104 had hypoglycemia,and HbAlc was(10.512.5)%,which was poorly controlled by blood glucose.(3)Compared with the non-insulin pump treatment group,the difference of HbAlc between the two groups of diabetic patients was statistically significant(t=6.2,p<0.001).(4)Serum metabolomics results showed that glutamate,leucine,lysine,1,5 sorbitan,hypoxanthine,arachidonic acid,etc.decreased with the prolongation of diabetes.Conclusion:There were more girls than boys in 311 children with type 1 diabetes in our center,with the highest number of patients between the ages of 5-10 years,the overall control of blood glucose was poor,HbAlc was(10.5±2.5)%.Some metabolic small molecules such as lysine,1,5 dehydration sorbitol,hypoxanthine and arachidonic acid may be used as early monitoring indicators for cardiovascular complications of type 1 diabetes. |
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