Obestatin levels are associated with C-peptide and anti-insulin antibodies at the onset whereas unacylated and acylated ghrelin levels are not predictive of long-term metabolic control in children with type 1 diabetes.

Context and objective: Ghrelin secretion is altered at the onset and after the start of insulin therapy in children with type 1 diabetes. Contemporary regulation of acylated (AG), unacylated ghrelin (UAG) and obestatin (OBST) remains undefined in this disease. It is unknown as to whether they could be good predictors of changes in glucose and metabolic control. Design, setting and subjects: A longitudinal study in a tertiary care center. AG, UAG and OBST were measured at baseline and after 2 years of follow-up in 51 children and adolescents with a history of type 1 diabetes extending beyond 1 year. A total of 33 healthy matched subjects were used as controls. Results: Age, puberty and BMI adjusted UAG levels were lower (p<0.005) and OBST levels were higher (p<0.009) in children with type 1 diabetes, with respect to controls. AG levels were similar to controls, but all ratios of three peptides are altered in diabetic patients. OBST (p<0.05) was negatively correlated with C-peptide (p<0.05) and IAA (p<0.008) at the onset of diabetes. In diabetic patients, baseline AG and UAG levels were negatively correlated with insulin dosage in the short- and long-term (p<0.001). AG, but not OBST, was positively correlated with C-peptide levels 2 years after diagnosis (p<0.05). Overall, the peptides were not predictive of glucose and metabolic control. Conclusions: UAG, AG, OBST and their ratios are differently regulated in children with type 1 diabetes suggesting a role in the metabolic balance of the disease, with insulin a likely regulator of AG and UAG. The peptides do not appear to be good long-term predictors of glucose control, with further investigations needed to explain if OBST could be a precocious predictor of islet dysfunction.