NEW ONSET TYPE 1 DIABETES MELLITUS (T1DM) IN CHILDREN-PREVALENCE OF SILENT GASTROPATHY ESTABLISHED BY MEANS OF ELECTROGASTROGRAPHY AND ITS CORRELATION WITH METABOLIC CONTROL

Abstract

Many studies have aimed at validating the use of electrogastrography (EGG) measurements as a noninvasive indicator of gastropathy and high prevalence of gastric myoelectrical dysrhythmias in diabetic subjects has been reported. Although little is known as regards the GI status in the early stage of diabetes, there is no available data concerning gastric myoelectrical activity in children with newly diagnosed T1DM. The aim: Was to evaluate the gastric myoelectrical activity in children with new onset (<1 year) T1DM in respect of metabolic control. Material and Methods: 42 children with T1DM duration of <1 year, aged 5-18 yrs (mean 12,87 ± 3,09 yrs) and 35 healthy controls were enrolled. In all subjects precutaneous EGG (PC Polygraff Synectics Medical Inc.) was performed. Fasting (30 min) and postprandial (60 min) periods were analyzed in terms of: the percentage of normogastria (2,4-3.6 cpm), bradygastria (<2.4 cpm), tachygastria (3,7-10 cpm), dominant frequency instability coefficient DFIC and power ratio PR. In subjects with T1DM hemoglobin A1c (HbA1c) (HPLC method) and blood glucose levels were measured (GLUKOTREND BOEHRINGER Mannheim). The evaluation of ANS was based on deep breath test and heart rate variability monitoring (HRV). The study protocol was approved by the Medical University Ethics Committee. Results: In all subjects, but one (2,38%), the screening for neuropathy was negative. In 28,57% of T1DM and 91.42% controls (p < 0.001) normal EGG criteria were fulfilled. The fasting and postprandial percentage of gastric dysrhythmias were significantly higher in T1DM subjects than in controls (p < 0,001). The significant difference between T1DM and controls was observed in he percentage of fasting bradygastria (53,13 ± 32,74% vs. 20 ± 17,81%; p < 0.01) and normal pre-prandial rhythm (36,97 ± 30,65% vs. 71,8 ± 13,74%; p < 0,01). In the postprandial period in T1DM normogastria was present in 50% subjects vs. 28,57% preprandially (p < 0,001), mean normogastria percentage increased (71,79 ± 22,89% vs. ±36,97 ± 30,65) and that of bradygastria decreased (22,04±20,44% vs. 53,13 ± 32,74%); the EGG signal proved to be more stabile (DFIC 57,25 ± 35,74 vs. 31,93 ± 22,11; p < 0,05). PR was comparable in T!DM and in controls (2,01 ± 2,33 vs 2,54 ± 1,18; NS). The percentage of fasting bradygastria and normogastria were correlated with glycemia (r = −0,55 and r = 0,51; p < 0,05), and postprandial DF with postprandial glycemia (r = 0,41; p < 0,05). There was no correlation between HbA1c and EGG. Conclusions: Our results proved that the derangement of the gastric myoelectrical activity is present in a high proportion of children with early stage of type 1 diabetes without neuropathy Glucose level influences gastric myoelectrical activity, whereas long-term metabolic control (HbA1c) does not correlate with EGG exponents in new onset T1DM children.