Background: Animal models of insulin-dependent diabetes show hyperactivity of hypothalamuspituitary adrenal (HPA) axis, independently of hypoglycaemia. Few data exists regarding type 1 diabetes (T1D) in children.
Objective: To describe HPA axis activity according to the anxiety levels in prepubertal T1D children.
Method: Prepubertal T1D children and siblings of T1D children (controls) were included. State-Trait Anxiety Inventory (STAI) test was performed at inclusion. Glucocorticoids metabolites (LCMS)/creatinine ratio on nocturnal urines and morning salivary cortisol (SC) were measured at home during five consecutive days without identified nocturnal hypoglycaemia. Expressed results were mean of the five samples for each child. Tetrahydrocortisol (THF) + allo-THF/tetrahydrocortisone (THE) ratio (i.e. THFs/THE ratio) was considered as an estimate of type 1 11β-hydroxysteroid dehydrogenase (11β-HSD1) activity.
Results: Forty-nine T1D children (mean age 9.0±1.7 yrs) and 26 controls (9.3±1.4 yrs) were recruited. STAI scores were not different between T1D children (29.7±6.6) and controls (33.0±7.8).Total glucocorticoid metabolites/creatinine were decreased in T1D children vs controls (552±170 vs 673±170 μg/mmol, P<0.01). THFs/THE was increased in TD1 children vs controls (0.46±0.10 vs 0.41±0.09, P=0.02). SC at awakening and 30 min after awakening (SC+30) were not different between groups. In both groups, STAI scores were associated with SC+30 when adjusted for BMI (controls β=−1.1, P=0.03; T1D children β=−1.0, P=0.04). STAI score was associated with THFs when adjusted for BMI in T1D children (β=−0.05, P=0.03) but not in controls.
Conclusion: Subtle changes of HPA axis activity, independently of recognized hypoglycemia, are present in prepubertal children with T1D, particularly for nocturnal glucocorticoid synthesis, 11β-HSD1 activity and its associations with anxiety.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology