Pancreatic shear wave elastography in children with type 1 diabetes: relation to diabetes duration, glycemic indices, fasting C-peptide and diabetic complications

Abstract

Background Little is known about changes in the pancreas as the course of type 1 diabetes progresses. Recently, shear wave elastography (SWE) emerged as a tool for assessing pancreatic stiffness in chronic pancreatitis and pancreatic cancer with a few studies assessing it in diabetes. Objective To compare pancreatic SWE in children with recent-onset and long-standing type 1 diabetes to healthy controls and to correlate it with diabetes duration, glycated hemoglobin (HbA1C), functional B cell reserve (fasting C-peptide) and diabetic complications. Materials and methods Fifty children with type 1 diabetes (25 with recent-onset and 25 with long-standing type 1 diabetes) and 50 controls were enrolled. Diabetes duration, insulin therapy, fundoscopic examination of the eyes and the neuropathy disability score were assessed. Fasting C-peptide, lipids, HbA1C and urinary albumin-creatinine ratio were measured. Pancreatic SWE was measured using the General Electric Logiq P9 ultrasound system. Results The mean SWE of the studied children with recent-onset type 1 diabetes was 4.81±0.62 kilopascals (Kpa), those with long-standing type 1 diabetes was 7.10±1.56Kpa and for controls was 5.57±0.27 Kpa (P<0.001). SWE was positively correlated to diabetes duration (P<0.001) and negatively correlated to fasting C-peptide (P<0.001). Regarding diabetes complications, SWE was positively correlated to frequency of severe hypoglycemia (P=0.005), HbA1C (P=0.03), low-density lipoproteins (P<0.001) and cholesterol (P<0.001) and significantly related to diabetic neuropathy (P=0.04) and nephropathy (P=0.05). Diabetes duration, fasting C-peptide, HbA1C and frequency of severe hypoglycemia were the significant independent variables related to SWE increase by multivariable regression analysis. Conclusion Pancreatic SWE changes significantly with duration of type 1 diabetes, being lowest in those with recent-onset type 1 diabetes and highest in those with long-standing type 1 diabetes, particularly those with diabetic nephropathy and neuropathy.

Secondary Prevention of Diabetes Type 1 with Oral Calcitriol and Analogs, the PRECAL Study

“…The median titer of IAA was 1.6, for IA2 it was 183.5, for GAD it was 10,6 and for ICA it was 1.4 in the T1D group and 1.35, 80.5 and 1.3, respectively, in the seropositive children receiving calcitriol or paricalcitol and did not differ significantly. This means that although T1Ab are related to the risk of T1D, they are not the primary mediators, and their presence or titers do not directly correlate with the degree of β-cell dysfunction [48].…”

Application of urine C-peptide creatinine ratio in type 2 diabetic patients with different levels of renal function

“…A study by Nouran et al. found that the levels of blood CP and 24-h UCP in T1DM patients were significantly lower than those in the control group and T2DM group, indicating poor secretion of insulin from the islet β-cells in T1DM patients ( 17 ). There were no significant differences in 24-h UCP between patients with normal renal function and patients with mild and moderate renal insufficiency, and 24-h UCP was positively correlated with blood CP ( 18 ).…”

Ultrasound Elastography in Children

“…Strain imaging showed increased strain ratios in children with type 1 diabetes mellitus, presenting an additional method for early detection, long-term screening and follow-up in children with type 1 diabetes mellitus [ 54 ]. Similarly, shear wave imaging changed significantly with duration of type 1 diabetes mellitus, particularly in those with diabetic nephropathy and neuropathy [ 55 ], but not all studies confirmed that [ 56 ].…”