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Abstract
Managing a patient with type 1 diabetes mellitus (T1DM) in adolescence is a difficult task due to the mechanisms of hormonal restructuring that are inherent in this pubertal period. According to the global data concerning molecular mechanisms which involves active metabolite of vitamin D in the processes of growth and development of the body, the presence of vitamin D receptors in many tissues, including pancreatic β-cells, it is important not only to study the effects of vitamin D on T1DM but also to assess the state of the skeletal system in adolescents with impaired carbohydrate metabolism. The aim of the study was to evaluate the course of diabetes mellitus against the background of vitamin D deficiency or insufficiency and analyze the state of the skeletal system in adolescents with T1DM. Materials and methods: 124 children aged 10 to 18 years were examined, including 91 children with T1DM (group 1) and 33 somatically healthy adolescents (group 2). The level of vitamin 25 (OH) D in the blood was determined by enzyme-linked immunosorbent assay using a «Cobas E411» analyzer («Roche Diagnostics International Ltd», Germany). Double energy X-ray absorptiometry (X-ray densitometry) was performed for assessing the skeletal system in adolescents. Assessment of the state of the skeletal system was performed according to the degree of reduction of bone mass (the Z-score values). Results. Analysis Z-score in adolescents found significantly lower mineral density of bone tissue in patients with T1DM compared with somatically healthy adolescents among both girls and boys (p<0.05). The incidence of vitamin D deficiency in adolescents with T1DM was twice higher than the incidence of vitamin D deficiency in adolescents without impaired carbohydrate metabolism. Structural and functional changes in the bone tissue significantly depended on the degree of vitamin D deficiency in adolescents with T1DM, regardless of gender. Conclusions. Determining the existing structural and functional changes in the skeletal system, as well as the degree of vitamin D supply among adolescents with T1DM is a necessary component of the assessment of bone metabolism during the period of gaining peak bone mass. The degree of vitamin D insufficiency in adolescents with T1DM affects the degree of disease compensation.
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