Vestibular function for children with insulin dependent diabetes using cervical vestibular evoked myogenic potentials testing

BACKGROUND Healthy vestibular system adjusts balance during static and dynamic conditions.This is important for normal development(standing up and walking).Vestipulopathies(central and peripheral)are common complications of diabetes in adult population.Related studies are scare in children with type 1 diabetes(T1D).AIM To assess saccular function of otolith organ in children with T1D and predictors for its dysfunction.METHODS Cervical vestibular evoked myogenic potential(cVEMP)was used for objective evaluation.RESULTS The study included 40 patients(boys=15;girls=25).Patients had mean age of 13.63±1.50 years,duration of diabetes of 5.62±2.80 years,frequent attacks of diabetic ketoacidosis(55%)and hypoglycemia(30%),hyperlipidemia(20%),hypertension(12.5%)and peripheral neuropathy(40%).Dizziness was found in 10%.Compared to healthy children(n=25),patients had prolonged cVEMP P1 and N1 latencies and reduced P1-N1 amplitude.Bilateral cVEMP abnormalities were found in 60%(vs 25%for unilateral abnormalities).Higher frequencies and severe vestibulopathies were found with chronic diabetes of>5 years,hemoglobin A1c values>7%,frequent diabetic ketoacidosis and hypoglycemic attacks and presence of dizziness.Regression analyses showed that predictors for prolonged P1 latencies and reduced P1-N1 amplitudes were only chronic diabetes(>5 years){odds ratio(OR)=2.80[95%confidence interval(CI):1.80–5.33],P=0.01;OR=3.42(95%CI:2.82–6.81)}and its severity(hemoglobin A1c>7%)[OR=3.05(95%CI:2.55–6.82),P=0.01;OR=4.20(95%CI:3.55–8.50),P=0.001].CONCLUSION Dysfunction or injury of the saccular macula and its pathways is prevalent in children with T1D.Optimum glycemic control is important to prevent diabetes related vestipulopathies.

Plasma adrenomedullin level in children with obesity: relationship to left ventricular function

Background Obese children are at increased risk for abnormal cardiac structure and function. Little is known about adre-nomedullin (AM), a cytokine produced in various organs and tissues, as a biomarker of cardiac hypertrophy in obese children. This study aimed to assess the plasma AM levels in a cohort of obese children and its relationship to left ventricular (LV) functions. Methods The study included 60 obese children and 60 non-obese children matched for age and gender as control group. Blood pressure, serum lipid profile, fasting glucose, insulin and plasma AM and the homeostatic model assessment of insulin resistance (HOMA-IR) were measured. Cardiac dimensions and LV functions were assessed using conventional echocardiography. Results Compared to control subjects, obese children had higher blood pressure (P = 0.01), insulin (P = 0.001), HOMA-IR (P = 0.001), and AM (P = 0.001). Moreover, obese children had higher LV mass index (LVMI) (P = 0.001), indicating LV hypertrophy;prolonged isovolumic relaxation times (P = 0.01), prolonged mitral deceleration time (DcT) (P = 0.01) and reduced ratio of mitralE-to-mitralA-wave peak velocity (P = 0.01), indicating LV diastolic dysfunction. Laboratory abnor-malities were only present in children with LV hypertrophy. In multivariate analysis in obese children with LV hypertrophy, AM levels were positively correlated with LVMI [odds ratio (OR) 1.14, 95% confidence interval (Cl) 1.08–1.13,P = 0.0001] and mitral DcT (OR 2.25, 95% CI 1.15–2.05,P = 0.01) in the presence of higher blood pressure and HOMA-IR. A cut-offvalue of AM at 52 pg/mL could differentiate obese children with and without left ventricular hypertrophy at a sensitivity of 94.32% and specificity of 92.45%. Conclusions Plasma AM levels may be elevated in obese children particularly those with LV hypertrophy and is correlated with higher blood pressure and insulin resistance. Measurement of plasma AM levels in obese children may help to identify those at high risk of developing LV hypertrophy and dysfunction.