Plasma ghrelin level in children with type 1 diabetes mellitus

Background: Type-1 diabetes mellitus(T1DM) is the commonest endocrine-metabolic disease in childhood. Ghrelin is a 28-amino-acid peptide hormone secreted predominantly by P/D1 cells lining the fundus of the stomach and epsilon cells of the pancreas that stimulates appetite with lesser amounts secreted by other cells. It is not clear which factors are involved in the regulation of ghrelin secretion in children with T1DM. Objective: This study aimed to estimate the level of pre-prandial plasma ghrelin level in children with T1DM and to clarify the relationship between its level and some parameters that may affect it as BMI, serum glucose and HbA1C levels and the effect of insulin therapy on its level. Methods: This study included 88 children, 66 diabetic children with type-1 diabetes mellitus(22 new-onset diagnosed diabetic children, 22 good glycemic controlled diabetic children on regular insulin therapy and 22 poor glycemic controlled diabetic children on insulin therapy) and 22 healthy controls. Diabetic children selected from the Diabetic Clinic and Inpatient Pediatric department, Minia University hospital from April 2009 to March 2010. Their ages ranged from 4 to 10 years with a mean 8.5 +/- 1.53 years. All children were subjected to history taking, clinical examination, anthropometric measurements and laboratory investigations included: Fasting and two hours post-prandial blood glucose, HbA1C, liver and renal function tests and pre-prandial plasma ghrelin level using enzyme linked immunosorbant assay (ELISA). Results: Pre-prandial plasma ghrelin levels were significantly higher in diabetic children than controls(24.4 +/- 21.4 & 9.8 +/- 3.6 pg/ml respectively, p value=0.002). Both new-onset and poorly controlled diabetic groups were significantly higher in plasma ghrelin levels (37.03 +/- 24.2 & 25.1 +/- 19.5 pg/ml, p value=0.001 & 0.001 respectively), but no significant difference between good glycemic controlled diabetic group and controls(11.09 +/- 9.6 & 9.8 +/- 3.6 pg/ml respectively, p value= 0.5). Significant negative correlations were found between ghrelin level and weight, weight on centile, BMI and BMI on centile,, fasting and 2 hours post prandial glucose levels in all diabetic children. No significant difference between males and females as regards ghrelin level was present. Conclusions: Children with T1DM had significantly higher levels of pre-prandial plasma ghrelin level. Its level increased in both of new-onset and poorly controlled diabetic children. Significant negative correlations between pre-prandial ghrelin level and weight, BMI, fasting and 2hours post-prandial levels were present. Insulin therapy plays an important role in normalizing plasma ghrelin level in good glycemic controlled T1DM children. No significant correlation between ghrelin and HbA1C was present.