Abstract
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
Highlights
Type 1 diabetes mellitus (T1DM) is a chronic metabolic disease with about 86,000 newly diagnosed children worldwide every year[1,2,3]
We investigated 53 pediatric type 1 diabetes mellitus (T1DM) patients in parallel to children suffering from chronic kidney disease and healthy controls
We focused on the exhalation of ethanol, acetone, isopropanol, dimethylsulfide, isoprene, pentanal, and limonene by pediatric T1DM patients
Summary
Type 1 diabetes mellitus (T1DM) is a chronic metabolic disease with about 86,000 newly diagnosed children worldwide every year[1,2,3]. In T1DM patients the duration of disease can approximate biological age, i.e. patients are at risk to suffer from diabetes related comorbidities already at young adult age[2,15,16] For this reason, long-term metabolic control is of great relevance and measures to maintain or even increase adherence to unpleasant metabolic control via an immediate feedback, rather than pointing to an invisible risk in the future are especially important. While breath gas analysis is certainly not suitable to assess the glycemic state, it might help to gain knowledge on metabolic adaption under conditions of real-life, i.e. simultaneous investigation of a broad panel of VOCs (“volatilome”) in real-time. This can e.g. be done with proton-transfer-reaction time-of-flight mass spectrometry (PTR-ToF-MS). Within the frame of this study, we invited children suffering from T1DM that were treated at our institution in order to examine volatile metabolites in the breath of pediatric T1DM patients and healthy controls
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