Prevalence of hepatic abnormalities in a cohort of Egyptian children with type 1 diabetes mellitus.
OBJECTIVE
Children with type 1 diabetes mellitus (T1DM) are frequently investigated for hepatic abnormalities. This study was carried out to report on the prevalence of hepatic abnormalities in diabetic children and adolescents and to highlight the possible etiology and appropriate management.


METHODS
The study included 692 children (333 were males) with T1DM attending the Diabetes Unit at Cairo University Pediatric Hospital. Their mean age was 9.65 ± 4.18 yr. All children were subjected to clinical examination for hepatomegaly, determination of alanine aminotransferase (ALT) and antibodies to hepatitis C virus (anti-HCV), and abdominal ultrasonography. All children with clinical, laboratory or ultrasound abnormality were counseled about proper glycemic control and followed up. If abnormalities persisted, more detailed investigations were carried out. HCV RNA was done for anti-HCV positive children.


RESULTS
Sixty (8.7%) were found to have one or more abnormalities: clinical hepatomegaly in 13 (1.9%), elevated ALT in 27 (3.9%), anti-HCV in 25 (3.6%) and abnormal hepatic ultrasound in 31 (4.5%). Forty percent of anti-HCV positive children were HCV-RNA positive. Glycogenic hepatopathy was diagnosed in three cases by liver biopsy. Abnormalities were reversible in 37/60 after proper glycemic control.


CONCLUSIONS
Although diabetic children are at risk of acquisition of HCV, poor glycemic control is the key factor that predisposes to hepatomegaly, elevated ALT and abnormal ultrasound findings. A 4 to 8-wk therapeutic trial of proper glycemic control is recommended prior to more invasive diagnostic procedures.
El-Karaksy
Hanaa Mostafa
HM
Pediatrics Department, Cairo University, Cairo, Egypt. hanaakaraksy@yahoo.com
Anwar
Ghada
G
Esmat
Gamal
G
Mansour
Samah
S
Sabry
Magda
M
Helmy
Heba
H
El-Hennawy
Ahmad
A
Fouad
Hanan
H
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006529:Hepatomegaly / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D014463:Ultrasonography
D001786:Blood Glucose; D018937:Hepatitis C Antibodies; D000410:Alanine Transaminase