ESPE Abstracts

Introduction: Type 1 diabetes mellitus (T1DM) remains the most common form of diabetes in young people. Little is known about the relationship between G6PD deficiency and DM. However, experimental observations support the hypothesis that hyperglycemia can lead to a decrease of G6PD activity, which is of major importance for defense against oxidative stress. Hyperglycemia may lead to the production of free radicals that are known to contribute to the pathogenesis and development of diabetic complications. Hence, the study aimed to determine if there is an association between G6PD deficiency and T1DM, and detect if there is a correlation between G6PD level in diabetic children and their glycemic control, and occurrence of diabetic retinopathy and nephropathy.

Methods: This case-control study included 60 T1DM children attending the Pediatric Diabetes Clinic at Alexandria University Children's Hospital, and they were compared to 60 age and sex-matched healthy controls. Patients with DKA, or those already diagnosed with hemolytic anemias were excluded. Patients were equally divided into 3 groups according to duration of DM: <2 years, 2-5 years, >5 years. Detailed history taking, and physical examination were done. Complete blood count, renal functions, fasting total cholesterol and triglycerides, HbA1c, C-peptide were assessed in all patients. Additionally, screening for microvascular complications in >5 year DM duration by fundus examination and urinary albumin/creatinine ratio were done. Erythrocyte G6PD enzyme activity was measured by spectrophotometry in all patients and controls.

Results: The mean age of patients ranged between 9.97±3.49 years. The majority of patients were males (53.3%). Only 2 patients (3.3%) had history of NICU admission with neonatal jaundice. Almost 56.7% of patients had 1 or 2 DKA episodes during the last year. The weight SD ranged between -2.22-2.7SD, and the mean height SD was -1.08±1.37 SD. The mean C-peptide level ranged between 0.33±0.29 ng/ml, and HbA1c at last folllow-up ranged between 4.6-14.6% (mean 9.50 ± 2.20%). Erythrocyte G6PD enzyme activity was significantly lower in cases than controls (16.75 vs 17.30 respectively, P = 0.045*). Duration of DM was negatively correlated with erythrocyte G6PD enzyme activity. However, there was no statistically significant correlation between erythrocyte G6PD enzyme activity with diabetes duration, C-peptide and HbA1c levels, or occurrence of DKA or microvascular complications.

Conclusion: Our study confirms that T1DM is associated with lower levels of G6PD. However, larger sample size with longer DM duration are required to detect if a correlation with microvascular complications exists.