Reduced bone geometry was explained only in part by reduced height. Bone disease in children with IBD seems to be secondary to muscle wasting, which is already present at diagnosis. With longer disease duration, bone adapts to the lower muscle CSA. Serum albumin concentration is a good marker for muscle wasting and abnormal bone development.

The IMT measurement detected subclinical atherosclerosis in a large cohort of diabetic children. Systolic blood pressure, total cholesterol level, insulin dosage, and age at onset of the disease were significantly related to the IMT. Longitudinal measurements may help to identify patients at special risk for atherosclerotic changes and cardiovascular disease.

OBJECTIVE -The aim of this study was to establish whether type 1 diabetes has a long-term effect on bone development in children and adolescents.RESEARCH DESIGN AND METHODS -Bone characteristics and muscle crosssectional area (CSA) were analyzed cross-sectionally in 41 (19 female and 22 male) patients and were reevaluated after 5.56 Ϯ 0.4 years using peripheral quantitative computed tomography (pQCT). We hypothesize that bone size and muscle mass normalize with age.RESULTS -At the first evaluation, mean Ϯ SD age was 9.87 Ϯ 2.3 years and disease duration was 4.31 Ϯ 2.9 years. Height was Ϫ0.36 Ϯ 1.9 SD, and BMI was 0.39 Ϯ 0.9 SD. Parameters of bone size were low in the whole patient group (corrected for patient's height). At reevaluation, age was 15.44 Ϯ 2.3 years, and patients had a mean height of Ϫ0.12 Ϯ 0.8 SD. BMI SD had increased to 0.57 Ϯ 1.1. Total and cortical CSA had normalized. Those patients with an increase in total CSA had a significant younger age at disease manifestation and a younger age at initial pQCT measurement. Bone size was well adapted to muscle mass expressed as the ratio of bone mineral content per muscle mass, and a close correlation was shown between the increase in bone size and in muscle CSA (r ϭ 0.46, P ϭ 0.03).CONCLUSIONS -Patients with manifestation of type 1 diabetes at an early age had transient impaired bone development. Within the follow-up period, the greatest increase in bone size was found in these patients. In adolescence, all patients had a normal bone size and appropriate adaptation of bone on muscle. There are still no conclusive data on the relative importance of several diabetesspecific characteristics, such as age at onset, disease duration, and glycemic control or insulin regimen, on bone health (6). Diabetes CareThe majority of earlier studies were cross-sectional using dual-energy X-ray absorptiometry of the spine. In pediatric patients, in particular, this method has l i m i t a t i o n s b e c a u s e o f t h e t w odimensional measurement and therefore height dependency. Longitudinal data on relatively small numbers of patients over 2-4 years revealed disturbed or normal bone development (7,8). A recently published study over a wide time range from 12 to 84 months showed slightly reduced mineralization of the spine independent of metabolic control or microvascular complications (9). The incidence of bone fractures was not increased in a large adult population with type 1 diabetes (10). Therefore, the clinical importance of possibly lower bone mineralization in type 1 diabetes is not clear.The objectives of the present longitudinal study were to evaluate bone mineral density (BMD) and bone size and muscle mass in patients with type 1 diabetes at two time points (5.5 years apart) using peripheral quantitative computed tomography (pQCT). Interpretation of BMD and geometry measurements is incomplete without taking into account muscle mass (11). Therefore, we looked at the ratio between bone mineral content (BMC) and muscle mass (12). RESEARCH DESIGN ANDMETHODS -In a ...

Aims Because reduction in baroreceptor sensitivity (BRS) has been associated with hypertension in the normal population and with increased cardiovascular morbidity and mortality in patients with diabetes mellitus, we measured BRS in a patient cohort of children with type 1 diabetes mellitus. Methods Two hundred and eight children (150 patients with type 1 diabetes mellitus, mean age 13.9±2.8 years, 70 boys, mean HbA 1c 7.8±1.4%; and 58 healthy controls, mean age 14.1±3.1 years, 32 boys) were studied. BRS and heart rate variability (HRV) were analysed from a shorttime ECG and BP recording using the sequence method (BRS) and the frequency domain method (HRV). Results There were 111 of 150 patients (74%) and 5 of 58 controls (8.6%) that showed impaired BRS. Mean BRS differed significantly between patients and controls (18.4± 7.2 vs 25.8 ± 8.2 ms/mm, p < 0.001). BRS correlated inversely with systolic BP (r=−0.23, p=0.009) and was related to diabetes duration (r=−0.194, p=0.027). Analysis of HRV showed greater sympathetic and less parasympathetic influence in patients than in controls (low frequency/ high frequency ratio 1.3±0.8 vs 0.9±0.6, p<0.05); the low frequency/high frequency ratio was inversely correlated with BRS (r=−0.28, p=0.001). Conclusions/interpretation Diabetic children show reduced BRS. In our patient group, the single risk factor for this finding was found to be the disease duration. The degree of BRS impairment was related to the degree of autonomic dysbalance.

Patients with CO-GHD should be retested after discontinuation of therapy to identify those who may profit from further replacement therapy. Patients with organic or genetic GHD or MPHD are likely to have persistent GHD, whereas 75% of our patients with idiopathic GHD showed normalization of growth hormone secretion. IGF-I levels alone are not reliable in the diagnosis of adult GHD in many cases. The best sensitivity and specificity scores were found when a GH cut-off level below 5.0 ng/ml was used in patients with GHD in the transition from childhood to adulthood.