Ultrasound Findings of Liver and Pancreas in Children with Type 1Diabetes Mellitus: A Case-Control Study

Abstract

Background: Type 1 diabetes mellitus (T1D), characterized by chronic hyperglycemia and insulin dependence, is caused by theautoimmune destruction of beta-cells in the pancreas. Diabetes mellitus can potentially lead to excessive accumulation of fat inthe liver, resulting in fatty liver. Changes in pancreatic tissue during the course of the disease can lead to decreased insulinsecretion and increased insulin resistance. Objectives: This study aimed to investigate the size and fat content of the liver and pancreas in children with T1D usingultrasound and to explore their relationship with clinical and laboratory indicators. Patients and Methods: In this case-control research, 43 children without diabetes made up the control group, whereas 43children with T1D (diagnosed based on American Diabetes Association criteria) between the ages of 3 and 18 years made up thecase group, from March 2020 until July 2021. A checklist was used to collect data on age, the duration of diabetes, insulin dose,gastrointestinal or liver symptoms, and autoimmune diseases. Moreover, the height and weight of patients were measured. Theresults of blood tests, including hemoglobin A1C (HbA1c), liver function tests, and autoantibodies related to diabetes, wereextracted from the files. A transabdominal ultrasound study was performed by two pediatric radiologists, with 8 years and 5years of experience, to evaluate the liver and pancreas regarding size and fat content. Correlation between laboratory testresults and ultrasound findings was assessed by statistical analysis. Data were analyzed using SPSS v26 with a significance levelconsidered less than 0.05. T-test, Fisher's exact test, and Partial correlation were the tests applied for data analysis. Results: The two groups had significant differences in aspartate aminotransferase (AST), alanine transaminase (ALT), alkalinephosphatase (ALP), bilirubin, and HbA1c levels, with higher values observed in diabetic subjects. There was no statisticaldifference between the two groups in terms of liver size. The frequency of fatty liver was higher in patients with T1D (65.1 indiabetic subjects versus 23.3 in non-diabetic subjects). The size of the body and tail of the pancreas in the case group wassignificantly lower than in the control group (10.33 +/- 2.87 vs. 12.30 +/- 2.1, P = 0.004 for the body, 9.47 +/- 2.4 vs. 10.86 +/- 2.2, P = 0.007for the tail). Fatty pancreas was more prevalent in T1D compared to the control group (P = 0.03). The size and grade of fattypancreas did not significantly correlate with the presence of autoantibodies. Liver size and body mass index were positivelycorrelated (P = 0.03). Conclusion: Patients with T1D are more susceptible to nonalcoholic fatty liver disease (NAFLD). Pancreatic morphologicalalterations, including increased echogenicity and a decrease in the size of the pancreas (particularly at the body and tail), can bedetected in ultrasound studies of children with T1D. Furthermore, no significant association was found between T1Dautoantibodies and pancreatic morphological changes, suggesting that autoantibodies cannot be used to predict futurepancreatic morphological alterations.