الفهرس 
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Abstract
Diabetes mellitus is a group of metabolic diseases characterized
by hyperglycemia resulting from defects in insulin secretion, insulin
action, or both. The chronic hyperglycemia of diabetes is associated
with long-term damage, dysfunction, and failure of various organs,
especially the eyes, kidneys, nerves, heart, and blood vessels.
Type 1 diabetes mellitus is the most common endocrinemetabolic
disorder of childhood and adolescence, with important
consequences for physical and emotional development.
Type 2 diabetes encompasses individuals who have insulin
resistance and usually have relative (rather than absolute) insulin
deficiency at least initially, and often throughout their life time.
Obesity is a medical condition in which excess body fat
accumulated to the extent that it may have an adverse effect on health,
leading to reduced life expectancy and/or increased health problems.
It is considered a major risk factor for chronic diseases. The
prevalence of chronic or noncommunicable disease is increasing
much more rapidly in developing countries than in industrialized
countries.
Children should be screened for T2DM if their calculated BMI
is in the 85th percentile or higher for age and gender and they have
additional risk factors for T2DM, such as family history or signs of
insulin resistance, through fasting and 2h post prandial blood sugar
level ,oral glucose tolerance testing along with HbA1c determination.
HbA1c is a form of hemoglobin that is measured primarily to
identify the average plasma glucose concentration over prolonged
periods of preceding 6–8 weeks.The HbA1c test has several advantages to the FPG and OGTT,
including greater convenience (since fasting is not required), evidence
to suggest greater pre-analytical stability, and less day-to-day
perturbations during periods of stress and illness.
The test was used as a prognostic measure until American
Diabetes Association recommended using HbA1c as a diagnostic test.
In 2009, An International Expert Committee that included
representatives of the ADA, The International Diabetes Federation
(IDF), and The European Association for the Study of Diabetes
(EASD) recommended the use of the A1C test to diagnose diabetes,
with a threshold of ≥6.5% ,and the ADA adopted this criterion in
2010 .
The values of HbA1c summarized as follow:
• Normal: less than 5.7%
• Pre-diabetes: between 5.7% and 6.4%
• Diabetes:6.5% or higher
Prediabetes is a state characterized by the presence of
antibodies against several islet cells antigens and preceding the
clinical onset of diabetes by months or even years.
Prediabetic patients should be informed of their increased risk
for diabetes as well as cardio-vascular diseases and counseled about
effective strategies to lower their risks .
The aim of this work was to study the value of HbA1c as an
early diagnostic marker of diabetes mellitus in high risk children.It was conducted on 60 children, their ages ranged from 2years
to 18years attended at the genetic and endocrine unit, Pediatric
department ,Menoufiya University divided into 2 groups:
• Group(A): 45 children as siblings of diabetic patients.
• Group(B):15 obese children ( according to BMI percentiles) as
follows:
Overweight children: BMI equal or more than 85th
percentile and less than 95th percentile.
Obese children: where BMI equal or more than 95th
percentile.
The studied groups were subjected to the followings:
• Detailed history taking.
• Family pedigree.
• Thorough clinical examination.
• Anthropometric measurements including weight ,height ,BMI
,waist circumference and waist to hip ratio.
• Laboratory investigations including:
(A)Routine investigations:
Complete blood count.
Estimation of random blood sugar (mg/dl).
Estimation of fasting and post-prandial glucose
level(mg/dl).
Evaluation of kidney functions by determining blood urea
and serum creatinine.
Evaluation of liver functions by determining liver
enzymes(ALT,AST)by enzymatic rate method.
Evaluation of thyroid functions by determining T3,T4
and TSH.
(B) Special investigations: HbA1c
Estimation of HbA1c to assess the glycemic control. It is done
by affinity chromatography.
Normal value of HbA1c less than 5.7%
Pre-diabetic value between5.7% and 6.4%
Diabetic value 6.5% or higher
• Family counseling.
• Data management and statistical analysis.
This study revealed that:
- The percentage of consanguinity in relatives of diabetic patients
was71.1% versus 28.9% with non consanguous relation.
- 6.7% of relatives of diabetic patients and 46.7% of obese group
showed android pattern of obesity.
- 8.9% of relatives of diabetic patients and 13.3% of obese children
had chronic bronchial asthma.
- 13.3% of relatives of diabetic patients and 20% of obese children
had hepatomegaly.
- 13.3% of relatives of diabetic patients were hypertensive.
- 6.7% of obese group showed acanthosis nigricans.
- 22.2% of relatives of diabetic patients were hypothyroidism.- The percentage of positive family history of relatives of diabetic
patients was100% regarding siblings. 20% of those were of parent
origin, 6.7% regarding father and 13.3% regarding mother.
- 66.7% of obese children had positive family history of obesity.
-There was highly significant difference among relatives of diabetic
patient and obese group regarding weight, BMI and head
circumference and significant difference regarding hip
circumference and sitting height. There is no significant
differences regarding height, span, waist circumference and waist
to hip ratio .
-The results of the present study reported higher levels of fasting
blood sugar that ranged between110-126 mg/dl and post prandial
blood sugar that ranged between 140-200 mg/dl in 4.4% (two
children) of relatives of diabetic patients and in 20% (three
children) of obese group being in prediabetic range.
- Regarding HbA1c % ,at the start five children were in pre-diabetic
range, of prediabetic patients two from sibling of diabetic patients
(4.4%) and three were obese (20%). At three months of follow up
HbA1c of the studied group, one of other siblings of diabetic
patients (2.2%) still in pre diabetic range while two of obese
children (13.3%) still in pre diabetic range. At six months of
follow up HbA1c of the studied group, other siblings of diabetic
patient return to normal range of HbA1c (%) while one obese
child (6.7%) still in pre diabetic range.A pediatrician should screen a child for prediabetes in the same
way as screening for diabetes. The testing is done when risk factors
for diabetes are present, such as obesity, darkening of the skin on the
back of the neck or armpits, and a family history of Type 2 diabetes.
The prediabetic child was advised to make life style
modifications, weight loss, physical exercise and follow up
investigation every six months by HbA1c.