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Possible Associations of Disturbed Neurometals and Ammonia with Glycaemic Control in Type 1 Diabetic Children with Attention Deficit Hyperactivity Disorder


The chronicity of type 1 diabetes mellitus (T1DM) is reported to be associated with various psychological disorders. The current study aimed to evaluate the levels of serum ammonia and various neurometals (zinc, copper, and magnesium) in patients with T1DM with and without ADHD and to correlate their levels with glycaemic status. A prospective case-control study was conducted with 60 diabetic children with T1DM (allocated into a group of 20 patients with a diagnosis of ADHD and a group of 40 patients without ADHD) who were comparable to 60 matched controls. Assays of glucose, glycated haemoglobin (HbA1c), ammonia, zinc, copper, and magnesium were performed. Overall, ammonia and copper levels were significantly higher in the diabetic patients especially those with ADHD than in the control group (p ˂ 0.05 for all). The calculated copper/zinc ratio was significantly higher in the diabetic patient group than in the control group and higher in diabetic children with ADHD than in diabetic children without ADHD (p ˂ 0.05 for all). Diabetic children had significantly lower magnesium levels than the controls (p ˂ 0.05), but no significant difference between the diabetic subgroups was detected. A positive correlation between glycaemic control (HbA1c %) and ammonia level was found in the diabetic group and subgroups, and a positive correlation was found between HbA1c % and the Cu/Zn ratio in diabetic children with ADHD (p ˂ 0.05 for all). The current study confirms an association of elevated ammonia and copper/zinc ratio with poor glycaemic control and ADHD development among children with T1DM.

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Author information

Study concept and design: HMS, MHH, and TD; patients’ selection and clinical evaluation: HM and TDS; blood sampling and laboratory workup: MHH; statistical analysis, manuscript writing, and literature research: HMS and MHH. The authors approved the final version of the manuscript.

Correspondence to Mohammed H. Hassan.

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The authors declare that they have no conflicts of interest.

Ethics Approval and Consent to Participate

The study was approved by the local Ethics Committee of Medical Research of the Faculty of Medicine, South Valley University, Qena, Egypt and was conducted in accordance with the Declaration of Helsinki. Informed written consent was obtained from every participant’s parents.

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Sakhr, H.M., Hassan, M.H. & Desoky, T. Possible Associations of Disturbed Neurometals and Ammonia with Glycaemic Control in Type 1 Diabetic Children with Attention Deficit Hyperactivity Disorder. Biol Trace Elem Res (2020).

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  • T1DM
  • Copper/zinc ratio
  • Magnesium
  • Ammonia
  • ADHD