Abstract
The present study on 28 diabetic and 38 non-diabetic children was conducted to extend information on the usefulness of HbAIa-c measurement in assessing the effectiveness of metabolic control, and to investigate to what extent HbAIa-c and blood glucose reflect changes in plasma cholesterol, especially high density lipoprotein cholesterol. Since the activities of serum lysosomal hydrolases are reported to be increased in diabetic patients, it was of interest to examine the changes in serum N-acetyl-β-D-glucosaminidase in relation to HbAIa-c.
Both fasting blood glucose and daily urinary glucose excretion were found to be positively related to HbAIa-c. The poorly controlled diabetic children exhibited the highest percentage of glycosylated haemoglobins. The total cholesterol and HDL-cholesterol content—as well as the activity of N-acetyl-β-D-glucosaminidase in the plasma—were also found to be directly related to the proportion of HbAIa-c. The measurement of glycosylated haemoglobins thus appears to be an important and useful aid in determining the effectiveness of long term control in juvenile diabetes. The interesting findings that HDL-cholesterol was significantly higher in diabetic children than in agematched controls, and that it was positively related to the fasting blood glucose and glycosylated haemoglobins, supports recent suggestions that there is an essential difference in plasma HDL-cholesterol between juvenile and adult onst diabetes. This fraction of plasma cholesterol, which represents a negative risk factor of coronary atherosclerosis, was significantly higher in the diabetic children than in patients with adult-onset diabetes.
Similar content being viewed by others
References
Belfiore, F., Napoli, E., Lo Vecchio, L.: Increased activity of some enzymes in serum in cases of severely decompensated diabetes with and without ketoacidosis. Clin. Chem. 18, 1403–1406 (1972)
Calvert, G. D., Graham, J. J., Mannik, T., Wise, P. H., Yeates, R. A.: Effects of therapy on plasma high-density-lipoprotein-cholesterol concentration in diabetes mellitus. Lancet 1978 II, 66–67
Castelli, W. P., Doyle, J. T., Fordon, T., Hames, C. G., Hjortland, M. C., Hulley, S. B., Kagan, A., Zukel, W. J.: HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study. Circulation 55, 767–772 (1977)
Chou, J., Robinson, A. C., Siegel, A. L.: Simple method for estimating glycosylated hemoglobins and its application to evaluation of diabetic patients. Clin. Chem. 24, 1708–1710 (1978)
Davis, R. E., Nicol, D. J., McCann, V. J., Calder, J. S.: Glycosylated haemoglobin levels in patients with diabetes mellitus. Med. J. Aust. 1, 530–532 (1978)
Ditzel, J., Kjaergaard, J.: Hemoglobin A1cconcentrations after initial insulin treatment for newly discovered diabetes. Brit. med. J. 1978I, 741–743
Dolhoffer, R., Städele, A., Wieland, O. H.: Clinical and biochemical studies on the significance and formation of hemoglobin A1c and A1a+b in diabetes mellitus. Klin. Wochenschr. 55, 945–954 (1977)
Durrington, P.: HDL-cholesterol in diabetes mellitus. Lancet 1978II, 206
Elkeles, R. S., Wu, J., Hambley, J.: Haemoglobin A1, blood glucose and high density lipoprotein cholesterol in insulin requiring diabetes. Lancet 1978II, 547–549
Fushimini, H., Tarni, S.: Retina, tear and serum β-N-acetyl-glucosaminidase activities in diabetic patients. Clin. chim. Acta 71, 1–8 (1976)
Gabbay, K. H., Hasty, K., Breslow, J. L., Ellison, R. C., Bunn, H. F., Gallop, P. M.: Glycosylated hemoglobin and longterm blood glucose control in diabetes mellitus. J. clin. Endocr. Metab. 44, 859–865 (1977)
Gonen, B., Rubenstein, A. H., Rochman, H., Tanega, S. P., Horwitz, D. L.: Haemoglobin A1: an indicator of the metabolic control of diabetic patients. Lancet 1977II, 734–736
Gordon, T., Castelli, W. P., Hjortland, M. C., Kannei, W. B., Daeber, T. R.: High density lipoprotein as a protective factor against coronary heart disease. Amer. J. Med. 62, 707–714 (1977)
Graf, R. J., Halter, J. B., Porte, D.: Glycosylated hemoglobin in normal subjects and subjects with maturity-onset diabetes. Diabetes 27, 834–839 (1978)
Huisman, T. H., Dozy, A. M.: Studies on the heterogeneity of hemoglobin: V. Binding of hemoglobin with oxidized glutathione. J. Lab. clin. Med. 60, 302–319 (1962)
Kennedy, A. L., Lappin, T. R. J., Lavery, T. D., Hadden, D. R., Weaver, J. A., Montgomery, D. A. D.: Relation of high density lipoprotein cholesterol concentration to type of diabetes and its control. Brit. med. J. 1978II, 1191–1194
Koenig, R. J., Peterson, C. M., Jones, R. L., Sondek, C., Lehrman, M., Cerami, M.: Correlation of glucose regulation and haemoglobin A1c in diabetes mellitus. New Engl. J. Med. 295, 417–420 (1976)
Koenig, R. J., Peterson, C. M., Kilo, C., Cerami, A., Williamson, J. R.: Hemoglobin A1c as an indicator of the degree of glucose intolerance in diabetes. Diabetes 25, 230–232 (1976)
Lange, R., Thiboult, N., Eschwege, E., Soria, J., Coria, C., Tschobroutski: Glycosylated hemoglobin concentrations and Clinitest results in insulin dependent diabetes. Lancet 1977II, 1156–1157
Medalie, J. H., Kahn, H. A., Neufeld, H. N., Reis, F., Goldbourt, H.: Five year myocardial infarction incidence. II. Association of single variables to age and birth place. J. Chron. Dis. 26, 325–349 (1973)
Meiattini, F., Prencipe, L., Bardelli, F., Giannini, G., Tarli, P.: The 4-hydroxybenzoate/4-aminophenazone chromogenic system used in the enzymic determination of serum cholesterol. Clin. Chem. 24, 2161–2165 (1978)
Miller, G. J., Miller, N. E.: Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. Lancet 1975I, 16–19
Nikkilä, E. A., Hormola, P.: Serum lipids and lipoproteins in insulin-treated diabetes. Demonstration of increased high density lipoprotein concentrations. Diabetes 27, 1078–1086 (1978)
Paulsen, E. P.: Hemoglobin A1c in childhood diabetes. Metabolism 22, 269–271 (1973)
Paulsen, E. P., Koury, M.: Hemoglobin A1c levels in insulin-dependent and-independent diabetes mellitus. Diabetes 25 (Suppl. 2), 890–896 (1976)
Rosenberg, D., Cuther, R.: Tay-Sachs carrier detection by mechanised serum hexosaminodase assay. Clin. Chim. Acta 53, 247–253 (1974)
Schonfeld, G., Birge, C., Miller, J. P. et al.: Apoliprotein B levels and altered lipoprotein composition in diabetes. Diabetes 23, 827–834 (1974)
Schröter, W., Jentsch, R., Stumpf, B., Kubel, R., Turner-Heckmann, E., Cahr, M.: Glycosylated hemoglobins and their relations to the control of juvenile diabetes mellitus. Helv. paediat. Acta 33, 535–542 (1978)
Steele, B. W., Kochler, D. F., Azar, M. M., Blaszkowski, T. P., Kuba, K., Dempsey, M. E.: Enzymatic determination of cholesterol in high-density lipoprotein fractions prepared by a precipitation technique. Clin. Chem. 22, 98–101 (1976)
Sugiura, M., Hirano, K.: A new colorimetric method for determination of serum glucose. Clin. chim. Acta 75, 387–391 (1977)
Trivelli, L. A., Ranney, H. M., Lai, H. T.: Hemoglobin components in patients with diabetes mellitus. New Engl. J. Med. 284, 353–357 (1971)
Wah Jun Tze, thompson, K. H., Leichter, J.: HbA1c an indicator of diabetic control. J. Pediat. 93, 13–17 (1978)
Whiting, P. H., Ross, I. S., Borthwich, L.: Serum and urine N-acetyl-β-D-glucosaminidase in diabetics on diagnosis and subsequent treatment in stable insulin dependent diabetics. Clin. chim. Acta 92, 459–463 (1979)
Woollen, J. W., Turner, P.: Plasma N-acetyl-β-glucosaminidase and β-glucuronidase in health and disease. Clin. chim. Acta 12, 671–683 (1965)
Author information
Authors and Affiliations
Additional information
Supported by the Scientific Research Council, Ministry of Health, Hungary (0701)
Rights and permissions
About this article
Cite this article
Klujber, L., Molnár, D., Kardos, M. et al. Metabolic control, glycosylated haemoglobin and high density lipoprotein cholesterol in diabetic children. Eur J Pediatr 132, 289–297 (1979). https://doi.org/10.1007/BF00496852
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00496852