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    Association of diabetic ketoacidosis and HbA1c at onset with year-three HbA1c in children and adolescents with type 1 diabetes: Data from the International SWEET Registry
    (Wiley, 2020) Piccini, Barbara; Schwandt, Anke; Jefferies, Craig; Kordonouri, Olga; Limbert, Catarina; Arslanoglu, Ilknur; Rami-Merhar, Birgit
    Objective To establish whether diabetic ketoacidosis (DKA) or HbA1c at onset is associated with year-three HbA1c in children with type 1 diabetes (T1D). Methods Children with T1D from the SWEET registry, diagnosed <18 years, with documented clinical presentation, HbA1c at onset and follow-up were included. Participants were categorized according to T1D onset: (a) DKA (DKA with coma, DKA without coma, no DKA); (b) HbA1c at onset (low [<10%], medium [10 to <12%], high [>= 12%]). To adjust for demographics, linear regression was applied with interaction terms for DKA and HbA1c at onset groups (adjusted means with 95% CI). Association between year-three HbA1c and both HbA1c and presentation at onset was analyzed (Vuong test). Results Among 1420 children (54% males; median age at onset 9.1 years [Q1;Q3: 5.8;12.2]), 6% of children experienced DKA with coma, 37% DKA without coma, and 57% no DKA. Year-three HbA1c was lower in the low compared to high HbA1c at onset group, both in the DKA without coma (7.1% [6.8;7.4] vs 7.6% [7.5;7.8], P = .03) and in the no DKA group (7.4% [7.2;7.5] vs 7.8% [7.6;7.9], P = .01), without differences between low and medium HbA1c at onset groups. Year-three HbA1c did not differ among HbA1c at onset groups in the DKA with coma group. HbA1c at onset as an explanatory variable was more closely associated with year-three HbA1c compared to presentation at onset groups (P = .02). Conclusions Year-three HbA1c is more closely related to HbA1c than to DKA at onset; earlier hyperglycemia detection might be crucial to improving year-three HbA1c.
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    Clinical Picture at Attendance and Response to Flexible Family-Based Low-Carb Life Style Change in Children With Obesity
    (Lifescience Global, 2021) Cakmak, Hatice Mine; Arslanoglu, Ilknur; Sungur, Mehmet Ali; Bolu, Semih
    Aim: The study aims 1) to determine the clinical status of obese children at the admittance to the pediatric endocrinology referral center 2) to investigate the efficiency and compliance of the low-carb diet in a pediatric population with or without exercise, metformin Material and Methods: All subjects with the complaint of obesity and BMI percentile >95 were recruited from January 2012-August 2014. We evaluated basal retrospectively, recommended low carbohydrate family-wide eating practice and exercise to all, and metformin to selected cases, and recorded Self- reported adherence at first, third, sixth, and twelfth months. Results: Thirty-six subjects used metformin with a higher ratio of weight loss (90.0%, p=0.010) without a difference in the number of lost kilograms. In 160 cases without metformin; diet only, exercise only, and both diet and exercise groups lost weight significantly according to neither diet nor exercise group (OR:12.08, 95% CI 3.93-41.66, p<0.001; OR:3.04, 95% CI 1.18-7.84, p=0.022 and OR:32.80, 95% CI 7.14-150.77, p<0.001 respectively). Exercise plus diet (95.3%, p=0,002) and only diet (88.9%, p=0,023) were even more efficient than exercise alone (65.5%). In the twelfth month, 13.8% were on follow-up. Conclusion: Obesity gives rise to metabolic complications in the very early stages. A low carbohydrate diet proved to be acceptable and useful. Long-term consistency remains a challenge.
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    Comparison of Anterior Segment Measurements in Obese Children and Healthy Control Group
    (Duzce Univ, Fac Medicine, 2023) Eski, Mehmet Tahir; Teberik, Kuddusi; Sezer, Taha; Arslanoglu, Ilknur
    Ophthalmology, Objective: To evaluate anterior segment parameters in obese children. Methods: Fifty-five obese and 30 control group children subjects participated. All participants and the control group were examined and anthropometric measurements were made. The measurements of fasting blood glucose (FBG), systolic blood pressure (SBP) triglyceride (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and insulin values were performed. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Each participant underwent a detailed ophthalmic examination and intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD) and lens thickness (LT) were measured. Results: The gender distribution of the groups was similar (p=0.893). The mean of CCT and LT were significantly higher in the obese group (572.9 & PLUSMN; 14.5 vs. 559.5 & PLUSMN; 10.1 & mu;m, p=0.001; 3.6 & PLUSMN; 0.14 vs. 3.48 & PLUSMN; 0.25 mm, p=0.007). No significant difference was found between the obese and control groups in terms of other parameters. Body mass index (BMI) and waist circumference (WC) had a significant negative correlation with LT control groups. The obese group showed a significant positive correlation between IOP and TG (r=0.276, p=0.042), and a significant negative correlation with HDL-C (r=-0.273, p=0.043). In the control group, there was a significant positive correlation between IOP and BMI (r=0.389, p=0.034), WC (r=0.497, p=0.005), HOMA-IR (r=0.384, p=0.036), Insulin (r=0.407, p=0.026), and a significant negative correlation with TC (r=-0.511, p=0.004). A significantly positive correlation between ACD and LDL-C (r=0.371, p=0.043) and a significantly negative correlation between HOMA-IR in the control group were detected (r=-0.682, p=0.000). Conclusions: The obese group had higher CCT and LT than the control groups.
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    The Effects of Long-term Growth Hormone Treatment on Ocular Findings
    (Georg Thieme Verlag Kg, 2023) Eski, Mehmet Tahir; Teberik, Kuddusi; Bolu, Semih; Ankarali, Handan; Kaya, Murat; Arslanoglu, Ilknur
    Purpose This study aimed to examine the long-term changes in anterior chamber depth (ACD), central corneal thickness (CCT), axial length (AxL), peripapillary retinal nerve fibre layer thickness (RNFLT), peripapillary ganglion cell layer - inner plexiform layer (GCL-IPL) thickness, and peripapillary choroidal thickness (ChT) after rhGH replacement treatment in paediatric patients with IGHD, compared to healthy controls.Methods Twenty-two children with IGHD including 12 girls and 10 boys were enrolled in the study group, and 30 (16 girls, 14 boys) healthy children composed the control group. A detailed ophthalmological examination was performed for each participant. ACD, CCT, AxL, peripapillary RNFLT, GCL-IPL thickness and ChT measurements were performed before the rhGH replacement treatment and in the 12th month of the post-treatment period, as well as the corresponding visits in the control group. AxL ultrasound pachymetry (CCT), peripapillary RNFL thickness, peripapillary RNFLT, GCL-IPL thickness, and peripapillary ChT parameters were measured by spectral-domain optical coherence tomography.Results The mean age of the groups were similar (p = 0.143). 12-month CCT, ACD, and AxL measurements of the study group showed significantly higher results than the pre-treatment measurements (p = 0.005, p = 0.024, and p = 0.002, respectively). Similarly, the mean RNFLT and ChT measurements of the study group obtained from all sectors were significantly higher in the 12th-month visit (p < 0.001 for both) other than the RNFLT, and GCL-IPL thickness measurements (p > 0.05 for all). However, all these parameters were similar at pre- and post-treatment visits in the control group (p > 0.05 for all). The mean pre-treatment values of all these parameters were significantly lower in the study group compared to the control group (p < 0.05 for all), other than the RNFLT, GCL-IPL thickness measurements (p > 0.05 for all), while the mean post-treatment values of all these parameters in both groups were similar at month 12 (p > 0.05 for all).Conclusion GH replacement treatment in childhood may play an important role in the development of the neural retina and can be effective on the anterior segment, RNFLT and ChT measurements.
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    Evaluation of the systemic-immune inflammation index (SII) and systemic immune-inflammation response index (SIRI) in children with type 1 diabetes mellitus and its relationship with cumulative glycemic exposure
    (Walter De Gruyter Gmbh, 2024) Ozde, Sukriye; Akture, Gulsah; Ozel, Mehmet Ali; Yavuzyilmaz, Fatma; Arslanoglu, Ilknur; Ozde, Cem; Kayapinar, Osman
    Objectives: In this study, the systemic proinflammatory status was assessed using the systemic immune-inflammation index (SII) and SIRI systemic immune-inflammatory response index (SIRI) in children and adolescents with type 1 diabetes mellitus (T1DM). Methods: The study involved 159 patients aged between 6 and 16 years. The SII and SIRI values were calculated based on the complete blood count. Basic blood biochemistry evaluated, and carotid intima-media thickness (cIMT) was measured and recorded. The cumulative glycemic exposure was calculated by multiplying the value above the normal reference range of the HbA1c value. The sum of all these values obtained from the time of diagnosis to obtain the cumulative glycemic exposure. All findings were compared statistically. All statistically significant parameters were evaluated in the multivariate logistic regression analysis. Results:The analysis revealed that only cIMT (Exp(B)/OR: 0.769, 95 % CI: 0.694-0.853, p<0.001), high-density lipoprotein (Exp(B)/OR: 3.924, 95 % CI: 2.335-6.596, p<0.001), monocyte count (Exp(B)/OR: 1.650, 95 % CI: 1.257-2.178, p<0.001), hematocrit (Exp(B)/OR: 0.675, 95 % CI: 0.523-0.870, p<0.001), and SIRI (Exp(B)/OR: 1.005, 95 % CI: 1.002-1.008, p<0.001) were significantly associated with T1DM. A statistically significant positive association was found between cumulative glycemic exposure and SIRI only (r=0.213, p=0.032). To our knowledge, this is the first study to evaluate SII and SIRI in children with type 1 diabetes. Conclusions: These findings indicate that SIRI could serve as a potential biomarker for detecting early-onset proatherosclerotic processes in diabetic children. However, further clinical studies are required to confirm this.
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    Genotype-Phenotype Characteristics of Turkish Children With Glucokinase Mutations Associated Maturity-Onset Diabetes of the Young
    (Springer India, 2020) Bolu, Semih; Eroz, Recep; Dogan, Mustafa; Arslanoglu, Ilknur; Dundar, Ismail
    Objective To investigate phenotype-genotype correlations in Turkish children with glucokinase gene mutations leading to Maturity-onset diabetes in young (GCK-MODY). Methods Retrospective analysis of 40 patients (16 girls) aged under 18 with GCK-MODY. Results Mean (SD) serum fasting blood glucose level was 6.79 (0.59) mmol/L and the mean (SD) HbA1c level at diagnosis was 6.3% (0.5). Sixteen different variations were detected in the GCK genes of the 40 cases; 33 missense mutations, 6 deletions, and one nonsense mutation. The birthweight of infants with deletion mutation was significantly lower than that of infants with other mutations [2460 (353.66) g vs 2944.11 (502.08) g]. Conclusion GCK-MODY patients with deletion mutation inherited from mothers had lower birthweight and higher fasting blood glucose than those with other inherited mutations but similar HbA1c values.
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    Serum 25-hydroxyvitamin D is associated with insulin resistance independently of obesity in children ages 5-17
    (Elsevier Sci Ltd, 2020) Gun, Emrah; Uzun, Hakan; Bolu, Semih; Arslanoglu, Ilknur; Kocabay, Kenan
    Aim: To determine the association of vitamin D with insulin resistance and obesity in children. Methods: A total of 92 obese and 58 non-obese children aged 5-17 years were evaluated. Data were collected related to anthropometric (weight, height), and biochemical parameters (fasting plasma glucose, serum insulin, serum 25-hydroxyvitamin D, lipid profile, vitamin B12, parathormone) and physical examination (blood pressure, acanthosis nigricans, stria, lipomastia). Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA). HOMA-IR = fasting insulin level (mu U/ml) x fasting glucose (mg/dL)/405. A HOMA-IR value >2.5 was defined as insulin resistance. Results: According to the US Endocrine Society classification, vitamin D deficiency (0-20 ng/ml) was determined at significantly higher rates in the obese group than in the control group (p < 0.001). The rate of subjects with a vitamin D level of 20-30 ng/ml was significantly lower in the obese group than in the control group (p < 0.001) Within the obese group a statistically significant difference was determined between the insulin resistant and non-insulin resistant groups in respect of serum 25-hydroxyvitamin D levels (p = 0.001) and vitamin B12 levels (p = 0.001). A significant negative correlation was determined between serum 25-hydroxyvitamin D and HOMA-IR (r=-0.256, p = 0.016) and insulin (r = -0.258, p = 0.015). The systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.003) values were significantly different in the control and obese groups. A statistically significant difference was determined between the control and obese groups in terms of the levels of insulin, HOMA-IR, HbA1c, cortisol, LDL, total cholesterol, HDL, triglyceride, hemoglobin, MCV, MPV, and calcium. Conclusion: The prevalence of vitamin D deficiency was higher in obese children compared to normal weight and overweight children. Serum 25(OH)D levels showed a negative correlation with insulin and HOMA-IR. Serum 25(OH)D is associated with insulin resistance independently of obesity. (C) 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.