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BackgroundThe number of children being diagnosed with type 1 diabetes mellitus (T1DM) is on the rise and has more than doubled in the past 10 years in Bahrain. Some studies have linked low vitamin D levels with an increased risk of diabetes. There are concerns regarding the variations in circulating 25(OH)D levels measured by different laboratories and by using different analytical techniques.ObjectiveThe aim of this study was to evaluate the vitamin D levels of newly diagnosed children with T1DM using the “gold standard method” with high-pressure liquid chromatography–tandem mass spectrometry methods compared to the chemiluminescence micro-particle immunoassay (CMIA) used in a hospital laboratory.SubjectsEighteen children, aged 6–12 years, who received a confirmed diagnosis of T1DM in 2014 were chosen as subjects.MethodsSerum vitamin D levels were assessed in a hospital, while an extra aliquot of blood collected during routine blood collection after acquiring informed written consents from the subjects, and sent to Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders to be analyzed by ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS).ResultsThe mean age of the study group was 9±2 years. The mean total of 25(OH)D levels (D3 and D2) assessed by UPLC-MS/MS was 49.7±18.8, whereas the mean total of 25(OH)D levels obtained from the CMIA assay was 44.60±13.20. The difference in classification between the two methods was found to be statistically significant (P=0.004). A Bland–Altman plot showed a poor level of agreement between the two assay methods. The CMIA overestimated insufficient values and underestimated deficiency, when compared to UPLC-MS/MS.ConclusionThere was a statistically significant difference between the two assay methods with CMIA overestimating vitamin D insufficiency. Clinicians should be prudent in their assessment of a single vitamin D reading, when the gold standard method is not available or feasible.

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In the Middle East approximately one in four adult deaths is attributed to diabetes (1) . Bahrain has not escaped the many challenges and consequences of diabetes with rates of childhood Type 1 diabetes mellitus (T1DM) more than doubling in the past ten years (2) . Whilst a healthy diet and lifestyle is important in maintaining good blood glucose control and preventing long-term complications (3) little or no data exists on the dietary intake or lifestyle of children living with T1DM in Bahrain. As part of an ongoing project characterising the Bahraini paediatric T1DM population, this paper presents data on the social and medical history of children with T1DM and healthy controls, in an attempt to elucidate the potential aetiology of the disease.Ethical approval was received from the Health Ethics and Research Committee of the Salamaniya Medical Complex in Bahrain, to undertake a descriptive case-control study of all children aged 6-12 years old receiving a confirmed diagnosis of T1DM in the years 2009 and 2010, compared with a matched control group of children recruited from primary health care centres. Data for cases was extracted from the Diabetes Registry Forms (DRF) completed for all newly diagnosed patients. These record the family's socio-demographic status, mother's pre and postnatal history, infant feeding practices, and the child's past medical history and family history of diabetes. Comparative data for cases was collected using an adapted version of the DRF administered by the local researcher. Height and weight of all children were measured using standardized methods at diagnosis/ recruitment. PASW (v19) was used to compare the characteristics of the cases and controls using independent t tests, Mann Whitney U tests and Chi Squared analysis as appropriate.The data for 59 cases and 60 controls were available for analysis. respectively).A significant association between economic situation and diabetes diagnosis was identified (p = 0.04) but this was due to more cases reporting their income as 'moderate' rather than a skew towards the 'high' or 'low' income bands. Children with diabetes were less likely to be Bahraini nationals (p < 0.001) but there was no significant difference in self-reported race with the majority of all children described as of Arab origin. A family history of T1DM was rarely reported, but cases were more likely to have a mother with T2DM (p = 0.03), gestational diabetes (p = 0.03) and gestational hypertension (p = 0.06) and, prior to diabetes diagnosis, to have suffered from other childhood illness (p < 0.001), most commonly tonsillitis, or to have undergone surgery (p = 0.004). No significant association between T1DM diagnosis and infant feeding was seen with over 90% of all children having received some breast milk and 59 % and 65 % of cases and controls respectively still receiving breast milk beyond 6 months.The aetiology of T1DM likely involves an interaction between genetic and environmental factors. Although unable to fully interrogate potential genetic differences this a...