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Background: Obesity affects approximately 45 millions of children worldwide. Some of them present with secondary dyslipidemia that leads to premature atherosclerosis., Aim of the Study: 1) Assessment of the frequency and type of dyslipidemia in obese adolescents. 2) An attempt at defining risk factors of atherogenic lipid profile in obese adolescents., Material and Methods: In 146 (84 girls/62 boys) obese (mean BMI SDS 4.95, 95% CI 4.62-5.29) adolescents (age 10-18, mean 14.7 years), the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglicerydes (TG) were measured. Atherogenic dyslipidemia was defined as a high TG level with a concomitant low HDLc level. Standard oral glucose tolerance test was performed with the assessment of fasting and after 120' post-load of 75 g of glucose and insulin levels; the insulin resistance index HOMA-IR was calculated., Results: The mean values of the lipid fractions were in normal ranges: TC 4.64 mmol/L (95% CI 4.48-4.8), LDLc 2.86 mmol/L (95% CI 2.73-2.99), TG 1.4 mmol/L (95% CI 1.3-1.5), and HDLc 1.16 (95% CI 1.1-1.2). However, in 50.69% of the patients (45.24% girls and 58.06% boys), elevated levels of TC, LDLc, and TG were observed respectively in 23.29%, 17.81% and 37.67%, and low HDLc in 15.07% of patients. A total of 10.96% of the patients presented with coexistence of a low HDLc and a high TG. In 26.7%, dyslipidemia was followed by arterial hypertension. There was a reverse correlation between a low HDLc value and BMI SDS [R (-) 0.22, p < 0.05] and not with TC, LDLc, and TG. The relative risk of abnormal lipid profile occurrence was higher in obese patients with insulin resistance (OR 1.72; 95% CI 0.8-3.4; p = 0.12), being significant only for boys (OR 3.67; 95% CI 1.1-12.1; p = 0.03). There was a reverse correlation between fasting insulin level, HOMA-IR and HDLc [R (-) 0.2; p < 0.05; R (-) 0.2; p < 0.05) respectively], as well as TG (R 0.26 ; p < 0.05; R 0.26; p < 0.05, respectively), and between post-load insulin level and TG (R 0.24; p < 0.05)., Conclusions: 1) Lipid disorders occur in about one-half of obese adolescents, of which 10% presents with atherogenic lipid profile. 2) One of the most important risk factors of atherogenic lipid profile occurrence is insulin resistance, especially in boys. The severity of the obesity (BMI-SDS) is of lesser importance.

Autoimmune thyroid disease (AITD) and type 1 diabetes mellitus (DM1) are much more common in Down Syndrome (DS) in comparison to the general population. The onset of DM1 may occur earlier than in the general population, often before age of 2 years, but AITD presents usually in the 2-3 decade of life, only sporadically before 10 years of age. The authors present a rare, unusual course of coincidence of AITD and DM1 in a 2-year-old girl with DS and congenital subclinical hypothyroidism.

The increase in diabetes type 1 incidence observed in various centers in Poland and the need for a centralized study covering large population have resulted in the construction of a standardized registry of type 1 diabetes in 1998 within the Polish Multicenter Study in Diabetes Epidemiology. The aim of the study was to present the incidence rates of type 1 diabetes in the age group 0-14 in 7 distinct regions of Poland (Krakow, Wroclaw, Warsaw, Bialystok, Poznan, Rzeszow and Olsztyn centers) with over 30% of the Polish population at risk in 1998 and 1999. The data for the standardized registry were obtained prospectively from paediatric hospital wards and diabetes outpatient units. The incidence rates calculated in 1998 showed the highest value of 14.6 and 14.5/100,000 for Olsztyn and Warsaw, and the lowest (8.4/100,000) for Poznan center. In 1999 the highest value of 14.7/100,000 was noted in Krakow and the lowest (9.3/100,000) in Poznan center. The differences in diabetes type 1 incidence rates between age groups 0-4, 5-9 and 10-14 were found to be significant (p < 0.0005) and were also significant when incidence rates were compared between males and females in these age groups in the whole study area in 1998-1999 (p = 0.002 and p = 0.015 respectively).

It is commonly known that there is a higher risk of diabetes type 1 in relatives of patients with diabetes type 1. According to some reports in families of these patients the incidence of diabetes type 2 is also higher. The aim of our study was the evaluation of incidence of diabetes type 1 and 2 in 1st and 2nd degree relatives of patients with diabetes type 1. Our study was conducted in the years 1993-2000 in the Department of Endocrinology for Children and Adolescents in Wrocław and in the Department of Endocrinology of Jagiellonian University in Cracow among relatives of all the patients in the age of 0-19 years with newly diagnosed diabetes type 1. Special prepared questionnaires were used in which patients were asked about: number of relatives of 1st and 2nd degree, age, sex and diagnosis of diabetes in the relatives. Data from families of 332 patients were obtained. They concerned 4080 relatives. Diabetes occurred in 121 relatives (2.96%). 20 of them were 1st degree relatives and 101--2nd degree relatives. In 31 relatives (0.76%) diabetes type 1 was diagnosed and in 88 relatives (2.16%) diabetes type 2 was diagnosed. Except for one individual (patient's mother) diabetes type 2 occurred in 2nd degree relatives. Diabetes type 1 was diagnosed in 16 1st degree relatives and 15 2nd degree relatives. They were: 1st degree relatives: 9 fathers, 3 brothers, 2 mothers and 2 sisters. 2nd degree relatives: in 8 cases siblings of patient's parents, in 7 grandparents. In families of diabetic children and adolescents relatives with type 1 and type 2 diabetes were observed, with a dominance of relatives with diabetes type 2 in 2nd degree relatives.

Percent of HbA1 was determined in 60 children with newly diagnosed diabetes mellitus at the beginning and end of their first hospitalization. High levels of HbA1 (over 15%) were found in the majority of children at the admittance which means late diagnosis. A decrease in HbA1 by 0.5-7.5% was noted in 76% of all diabetic children treated at the hospital for 7-24 days. In 54% out of these children HbA1 levels decreased by 1.5-4.5%. Mean HbA1 value was 3.6% following a two-week hospitalization, and 3.7%--after 3 weeks. Mean decrease in HbA1 for all treated children was 0.18% per week. Positive correlation between HbA1 and its percentage and mean glycaemia at the beginning of hospitalization was seen. No correlation between HbA1 values measured at the end of hospitalization and blood glucose levels determined during the whole hospitalization period was found.

Blood serum fructosamine and blood glycosylated hemoglobin (HbA1) concentrations were determined in 47 children with newly diagnosed insulin-dependent diabetes during their first stay in the hospital. Three determinations at week's intervals were carried out in each patient. The mean values of concentration decrement after the first, second and third week of treatment were 0.47, 0.37 and 0.26 mmol/l, respectively, (median values 0.56, 0.33 and 0.17 mmol/l) for fructosamine concentration, and 1.8, 2.9 and 1.0% (median 1.5, 2.3 and 0.8%) for HbA1. No correlation was found between the weekly decrement values in fructosamine and HbA1 concentrations when all the values were taken into consideration, and only a slight positive correlation when the decrement after two weeks of treatment was considered (r = 0.57, p < 0.05). Very high rate of decrease in the concentration of glycosylated hemoglobin was noted in some children, reaching the values from 4 to even 8.6% per week.

The study was aimed at assessing the results of diabetes mellitus therapy in 162 children, who underwent 1) the full programme of diabetes education (114 children) and 2) only the part of it (48 children). The first group was under care of Cracow Medical School Pediatrics Institute since the disease and had 2 weeks of formal diabetes mellitus teaching. The second group was treated in a less unified way in different hospitals and did not have the chance of regular teaching programme. The degree of metabolic control was assessed by series of Hb A1c determinations in whole 1987 year. The levels of Hb A1c were also compared with the children age, diabetes mellitus duration and the period elapsing from the time of last teaching. Children who were fully educated in the problems of their disease achieved significantly better results. In all group a deterioration of diabetes control during puberty was however observed. In children not fully educated such a deterioration was also noted in correlation with diabetes mellitus duration.