Cytokine response to diabetic ketoacidosis (DKA) in children with type 1 diabetes (T1DM)

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  • Karavanaki Kyriaki
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Karanika Evangelia
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Georga Soultana
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Bartzeliotou Anastasia
    Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
  • Tsouvalas Manolis
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Konstantopoulos Ilias
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Fotinou Aspasia
    Hormones Laboratory, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece
  • Papassotiriou Ioannis
    Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
  • Karayianni Christina
    Diabetic Clinic, B’Paediatric Department, University of Athens Medical School, “P.&A.Kyriakou” Children’s Hospital, Athens, Greece

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Description

It has been suggested that cytokine release during DKA may result in capillary perturbation and thus may contribute to the development of its acute clinical complications (i.e.cerebral or pulmonary edema). We studied in 38 newly diagnosed T1DM children with DKA, aged 7.68±3.07 years, plasma levels of cytokines IL-1β (interleukin-1β), IL-2, IL-6, IL-8, IL-10, TNF-α (tumour necrosis factor-α) and also WBC (white blood cell count), hs-CRP (high sensitivity C-reactive protein), GH (growth hormone) and cortisol, prior to, during and 120h after DKA management, with the aim to monitor their levels at different time-points and in different degrees of DKA severity. Prior to DKA management the levels of IL-6, IL-8, IL-10, WBC and cortisol were elevated, but were all reduced within 120h after DKA management. Then the patients were divided into two groups: a. moderate/severe: pH≤7.2, b. mild DKA: pH>7.2. In the group with moderate/severe DKA (ph≤7.2), IL-10 levels were the highest of all cytokines, but were significantly decreased after 6h (91.76 vs 18.04 pg/mL, p=0.008), with no further change, while IL-6 levels were decreased at 120h (28.32 vs 11.9 pg/mL, p=0.003). The above were not observed in the group with mild DKA. In conclusion, in the children with DKA of our study, in the group with moderate/severe DKA the IL-10 levels were prematurely reduced at 6 hours, while the IL-6 levels remained high and were reduced at 120 hours after the DKA management. These changes may be responsible for increased capillary perturbation, which could lead to the subsequent development of acute DKA complications.

Journal

  • Endocrine Journal

    Endocrine Journal 58 (12), 1045-1053, 2011

    The Japan Endocrine Society

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