Effect of Glycated Haemoglobin Deviations on Glomerular Filtration Rate and Electrolyte Homeostasis among Paediatric Patients with Type I Diabetes Mellitus

Abstract

Introduction: Hyperglycaemia-induced electrolytic imbalance is a major contributing factor for the onset of complications observed in diabetes and other endocrine disorders. Children with Type I Diabetes Mellitus (T1DM) often exhibit electrolyte disturbances which contribute early onset of diabetic complications. Hyperglycaemia-induced electrolytic imbalance is a major contributing factor for the onset of complications observed in diabetes and other endocrine disorders. Aim: To assess the effect of glycated haemoglobin deviations on estimated Glomerular Filtration Rate (eGFR) and electrolytes (sodium, potassium, calcium, and magnesium) in paediatric subjects with T1DM. Materials and Methods: This retrospective study was conducted at King Abdullah Specialized Children's Hospital (KASCH)/NGHA, Riyadh, Saudi Arabia, a tertiary care teaching hospital. Total 78 paediatric T1DM patients with 5 year diabetes duration registered at the hospital for medical and nutritional care from January 2013 to December 2013, formed the study population. Data related to demography (age, gender, body mass index) and biochemical variables {Haemoglobin A1C (HbA1c), total cholesterol, LowDensity Lipoprotein (LDL), High-Density Lipoprotein (HDL), Triglyceride (TG), urea, and serum creatinine, data related to electrolytes such as sodium, potassium, magnesium, calcium, and vitamin D} were extracted from the hospital information system. Frequencies, percentages, mean, standard deviation, student’s t-test, tertiles with percentages, analysis of variance and Pearson correlation coefficient were used to analyse the data by statistical software Statistical Package for the Social Sciences (SPSS) (version 22.0). Results: A total of 31 males and 47 females between ages 6-14 years were included in this study. eGFR (p-value=0.004) and sodium (p-value=0.013) were independently associated with HbA1c in T1DM even after adjusting the confounding factors such as age, BMI, and LDL. Whereas, other electrolytes (potassium, magnesium) and vitamin D showed an inverse relation with HbA1c but were not significant after adjusting for confounding factors (p-value <0.05). Serum creatinine (r-value=0.313, p-value=0.005) indicated a significant positive correlation with HbA1c while, eGFR (r-value=-0.344, p-value=0.002) and sodium (r-value=- 0.236, p-value=0.040) showed a significant negative correlation with HbA1c. Conclusion: Maintaining a balance between glycaemic control and nutritional therapy is essential to avoid the progressive development of diabetic complications in T1DM. In addition, early diagnosis, proper medications, including adequate insulin therapy and dietary supplements are needed to prevent diabetic complications.