Endocrine Abstracts

Objective: To study serum levels of angiogenic factors: vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), angiogenin and transforming growth factor-beta 1 (TGF-beta 1) and their relationship to metabolic control in children and adolescents with type 1 diabetes mellitus and to evaluate whether these angiogenic factors can predict and identify cases at greater risk to develop diabetic retinopathy or persistent microalbuminuria in a follow-up period of 12 months.

Subjects and Methods: The present study included 20 type 1 diabetic cases aged 6-18 years and 15 healthy controls. Diabetic cases were subjected to history taking, clinical examination, fundus examination, electroretinography (ERG) and repeated estimation of glycosylated haemoglobin (HbA1c%) and fasting blood glucose and urinary albumin excretion (UAE) micrograms/minute/1.73m²in repeated 24 hours collection of urine at the baseline (at the start of the study), during and after 12 months follow-up period. Baseline investigations included the determination of blood urea, serum creatinine and assessment of serum angiogenic factors: VEGF, bFGF, angiogenin and TGF-beta 1 by ELISA.

Results: At the start of the study, diabetic cases had significantly higher serum VEGF, bFGF and angiogenin and significantly lower oscillatory potentials amplitude (Ops) in ERG examination than the control group. After 12 months, 4/20 cases developed background retinopathy and 5/20 developed incipient nephropathy (persistent microalbuminuria). These cases had significantly higher HbA1c%, serum VEGF, bFGF and angiogenin than uncomplicated cases. Angiogenic factors identified diabetic cases at high risk to develop diabetic retinopathy with a sensitivity of 75-100% and specificity of 81.25-93.75% and in prediction of incipient diabetic nephropathy with a sensitivity of 60-100% and a specificity of 86.67-93.33%.

Conclusion: Measurement of angiogenic factors and ERG examination are important to predict cases at high risk for development of microvascular complications in type 1 diabetes.