Ferritin levels in children and adolescents with type 1 diabetes mellitus: relationship with microvascular complications and glycemic control

Abstract

Objective: Evaluate ferritin levels in children and adolescents with type 1 diabetes mellitus and its relation to diabetic microvascular complications, and metabolic control. Subjects and methods: This study included 180 children and adolescents with type 1 diabetes mellitus (T1DM) with a mean age of 14.9 ± 3.1 years and 180 apparently normal children matched for age and sex (control group). All children were evaluated with full history taking, thorough clinical examination, laboratory assessment of high-sensitivity C-reactive protein and hemoglobin A1c (HbA1c), and evaluation of the presence of microvascular complications. Serum ferritin levels were measured using electrochemiluminescence immunoassay. The patients were divided into two groups according to the presence or absence of microvascular complications. Results: Serum ferritin levels were significantly higher in patients with T1DM in both groups compared with healthy controls (p < 0.001). Additionally, patients with microvascular complications had higher serum ferritin concentrations than those without microvascular complications (p < 0.001). Patients with microalbuminuria showed higher ferritin levels compared with patients without microalbuminuria (p < 0.05). Stepwise regression analysis revealed that levels of HbA1c and urinary albumin excretion were independently related to ferritin levels (p < 0.001 for both). On receiver operating characteristic (ROC) curve analysis, a ferritin cutoff value of 163.6 ng/mL differentiated patients with microvascular complications from those without microvascular complications with a sensitivity of 92.1% and specificity of 93.4%. Conclusion: Serum ferritin levels are elevated in T1DM, particularly in patients with microvascular complications.

Ferritin – novel uses of a well-known marker in paediatrics

“…A study by Metwalley et al comparing ferritin levels in children with type 1 diabetes to healthy controls showed that ferritin levels were considerably higher (p < 0.001). In a diabetic group after controlling for age, gender, illness duration, BMI, blood pressure, HbA 1c , urine albumin excretion, and fasting lipids, ferritin was found to be an independent predictor of microvascular complications frequently observed in diabetic individuals (p < 0.001) [36]. What is more, a cut-off value of ferritin was found in patients with microvascular complica-tions (163.6 μg/l, with sensitivity of 92.1% and specificity of 93.4%) [36].…”

“…In conclusion, the elevated ferritin levels in both adults and children are associated with metabolic syndrome, IR and abdominal fat [29], dyslipidaemia [31], diabetes [36], NAFLD [32], and hypertension [34].…”

“…Patients with diabetes mellitus type 1 (T1DM) have higher ferritin levels (p < 0.001) than healthy individuals [36,41]. Ferritin causes excessive capillary permeability in the inflammatory pathway, glomerular basement membrane thickening, and apoptosis of the endothelial cells [36].…”