Serum elemental profiles and their associations with glycemic control in pediatric type 1 and type 2 diabetes

doi:10.4239/wjd.122649

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World Journal of Diabetes

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1948-9358

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Observational Study

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World J Diabetes. Aug 15, 2026; 17(8): 122649
Published online Aug 15, 2026. doi: 10.4239/wjd.122649

Table 1 Characteristic features of children and adolescents with type 1 diabetes mellitus and type 2 diabetes mellitus, n (%)

Diabetes type	T1DM	T2DM	P value	Overall DM
Patients	221 (52.5)	200 (47.5)	0.33	421 (100)
Gender
Male	127 (57.47)	69 (34.5)	< 0.0001	196 (46.56)
Female	94 (42.53)	131 (65.5)	0.02	225 (53.44)
Age (examination), years, median (IQR)	12.49 (4.64)	15.37 (2.94)	< 0.0001	14.07 (3.98)
Race/ethnicity
Hispanic	60 (27.15)	109 (54.5)	< 0.0001	169 (40.14)
Non-Hispanic	153 (69.23)	89 (44.5)	< 0.0001	242 (57.48)
American Indian/Alaskan Native	3 (1.36)	1 (0.5)	0.63	4 (0.95)
Asian	4 (1.8)	5 (2.5)	1.00	9 (2.14)
Black/African American	12 (5.43)	56 (28)	< 0.0001	68 (16.15)
Mixed race	5 (2.26)	9 (4.5)	0.42	14 (3.33)
Native Hawaiian/Other Pacific Islander	0 (0.00)	1 (0.5)		1 (0.24)
White	129 (58.37)	17 (8.5)	< 0.0001	146 (34.68)
Unknown/not reported	8 (3.62)	2 (1.00)		10 (2.38)
Weight, kg, median (IQR)	50 (28)	93.55 (35.13)	< 0.0001	69 (46.05)
Height, cm, median (IQR)	154.4 (29.6)	165 (11.38)	< 0.0001	161.6 (18.2)
BMI, percentile, median (IQR)	74.95 (36.84)	98.77 (2.45)	< 0.0001	94.07 (26.67)
BMI Z-score, median (IQR)	0.67 (1.16)	2.25 (0.67)	< 0.0001	1.56 (1.68)
Blood pressure, mmHg, median (IQR)
Systolic	107 (16)	122 (14)	< 0.0001	114 (19)
Diastolic	64 (10)	69 (13)	< 0.0001	66 (12)
Diabetes duration, years, median (IQR)	3.13 (0.93)	2 (2.62)	< 0.0001	2.93 (1.59)
HbA1c, percent, median (IQR)	8 (1.7)	7.1 (3.18)	< 0.0001	7.7 (2.3)
Glucose, mg/dL, median (IQR)	176 (134)	119 (103)	< 0.0001	146 (132)
BUN, mg/dL, median (IQR)	13 (6.8)	11 (4)	< 0.0001	12 (5.45)

The statistical analysis was conducted using the independent-samples Mann-Whitney U test, a nonparametric method. Interquartile range: A single number as a result of this mathematical equation (interquartile range = 75th percentile - 25th percentile). T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; DM: Diabetes mellitus; IQR: Interquartile range; BMI: Body mass index; BUN: Blood urea nitrogen; HbA1c: Hemoglobin A1c.

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Table 2 Statistical analysis of elemental concentrations in serum samples of children and adolescents diagnosed with type 1 diabetes mellitus and type 2 diabetes mellitus, median (interquartile range)

Diabetes type	T1DM (n = 221)	T2DM (n = 200)	P value (T1DM vs T2DM)
Na, mg/dL	299.7 (19.65)	297.92 (22.19)	> 0.99
K, mg/dL	16.39 (9.45)	16.09 (2.52)	0.25
Mg, mg/dL	1.98 (0.22)	1.89 (0.23)	< 0.0001
Ca, mg/dL	9.03 (1.1)	9.07 (1.24)	> 0.99
Fe, μg/dL	96.58 (95.21)	82.96 (108.75)	0.13
Cu, μg/dL	110.1 (28.07)	122.38 (30.48)	< 0.0001
Zn, μg/dL	73.93 (17.55)	80.28 (18.76)	< 0.0001
Zn/Fe ratio	0.75 (0.62)	0.95 (1.25)	0.0008
Zn/Cu ratio	0.66 (0.22)	0.65 (0.25)	> 0.99
Se, μg/dL	107.75 (35.87)	109.71 (35.87)	> 0.99
Mn, μg/dL	2.31 (4.72)	2.05 (4.09)	> 0.99
Co, μg/dL	0.22 (0.18)	0.13 (0.13)	< 0.0001
Al, μg/dL	127.92 (284.71)	115.33 (218.61)	0.63
Ni, μg/dL	0.58 (1.07)	0.49 (0.8)	> 0.99
Sb, μg/dL	1.69 (0.8)	1.42 (0.71)	0.0001
Ba, μg/dL	2.7 (6.9)	4.57 (11.33)	0.058

The statistical analysis was conducted using the Mann-Whitney U test, a nonparametric method. Interquartile range: A single number as a result of this mathematical equation (interquartile range = 75th percentile - 25th percentile). T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; Na: Sodium; K: Potassium; Ca: Calcium; Mg: Magnesium; Fe: Iron; Cu: Copper; Zn: Zinc; Se: Selenium; Mn: Manganese; Co: Cobalt; Al: Aluminum; Ni: Nickel; Sb: Antimony; Ba: Barium.

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Table 3 Comparative analysis of Hispanic and non-Hispanic subpopulations with type 1 diabetes mellitus

Ethnicity	Hispanic (n = 60, 27.2%)¹		Non-Hispanic (n = 153, 69.2%)¹		P value
Ethnicity	Median	IQR	Median	IQR	P value
Age (examination), years	12.25	5.09	12.54	4.55	0.9
Weight, kg	46.75	25.60	50.30	30.05	0.6
Height, cm	151.30	24.80	156.80	30.50	0.1
BMI, percentile	79.81	37.09	73.94	38.13	0.4
BMI Z-score	0.84	1.25	0.64	1.20	0.4
Systolic BP, mmHg	110.50	15.70	106.00	14.00	0.1
Diastolic BP, mmHg	64.00	13.75	64.00	8.50	0.9
Diabetes duration, years	3.05	0.98	3.17	0.86	0.5
HbA1c, percent	7.75	1.50	8.00	1.70	0.5
Glucose, mg/dL	179.00	123.20	171.00	143.00	0.5
BUN, mg/dL	14.00	5.25	13.00	6.60	0.7
Na, mg/dL	303.2	17.65	298.05	20.18	0.01
K, mg/dL	16.08	3.87	16.58	13.61	0.52
Mg, mg/dL	1.97	0.29	1.98	0.20	0.97
Ca, mg/dL	8.93	1.41	9.05	1.00	0.5
Fe, μg/dL	106.30	94.64	95.46	94.85	0.1
Cu, μg/dL	97.25	20.08	113.60	26.30	< 0.0001
Zn, μg/dL	73.56	15.62	73.93	19.03	0.62
Zn/Fe ratio	0.73	0.68	0.74	0.62	0.86
Zn/Cu ratio	0.74	0.25	0.64	0.20	0.0002
Se, μg/L	107.50	40.69	107.70	34.30	0.37
Mn, μg/L	1.96	2.27	2.58	5.25	0.19
Ba, μg/L	2.34	7.25	2.88	7.41	0.87

¹This number is for all parameters included in the table, except certain parameters as follows: Blood urea nitrogen [n = 34 (15%) for Hispanic, and n = 76 (34.4%) for non-Hispanic]. Manganese [n = 26 (11.8%) for Hispanic, and n = 77 (34.8%) for non-Hispanic]. Barium [n = 37 (16.7%) for Hispanic, and n = 88 (39.8%) for non-Hispanic]. Glucose [n = 151 (68.3%) for non-Hispanic]. Iron [n = 152 (68.8%) for non-Hispanic]. Unknown ethnicity (n = 8).

The statistical analysis was conducted using the independent-samples Mann-Whitney U test, a nonparametric method. Interquartile range: A single number as a result of this mathematical equation (interquartile range = 75th percentile - 25th percentile). IQR: Interquartile range; BMI: Body mass index; HbA1c: Hemoglobin A1c; BP: Blood pressure; BUN: Blood urea nitrogen; Na: Sodium; K: Potassium; Ca: Calcium; Mg: Magnesium; Fe: Iron; Cu: Copper; Zn: Zinc; Se: Selenium; Mn: Manganese; Ba: Barium.

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Table 4 Comparative analysis of male and female subpopulations in type 1 diabetes mellitus

Gender	Males (n = 127, 57.5%)¹		Females (n = 94, 42.5%)¹		P value
Gender	Median	IQR	Median	IQR	P value
Age (examination), years	13.03	4.43	12.06	4.61	0.2
Weight, kg	52.10	28.10	46.95	26.40	0.3
Height, cm	159.00	27.30	150.30	24.20	0.001
BMI, percentile	71.13	33.91	81.88	43.38	0.1
BMI Z-score	0.56	1.03	0.91	1.42	0.1
Systolic BP, mmHg	109.00	18.00	104.00	13.00	0.048
Diastolic BP, mmHg	63.00	11.00	65.00	8.00	0.4
Diabetes duration, years	3.15	0.87	3.07	1.01	0.5
HbA1c, percent	7.90	1.50	8.00	1.90	0.1
Glucose, mg/dL	186.00	148.20	171.00	113.00	0.8
BUN, mg/dL	15.00	6.00	12.00	5.95	0.001
Na, mg/dL	298.83	19.22	301.93	19.68	0.29
K, mg/dL	16.38	5.3	16.49	11.99	0.4
Mg, mg/dL	1.98	0.23	2.00	0.22	0.2
Ca, mg/dL	9.02	1.14	9.05	1.07	0.9
Fe, μg/dL	93.05	91.76	102.30	110.07	0.5
Cu, μg/dL	110.40	26.90	109.60	29.74	0.6
Zn, μg/dL	75.07	17.80	73.42	17.44	0.5
Zn/Fe ratio	0.78	0.58	0.70	0.73	0.5
Zn/Cu ratio	0.67	0.21	0.65	0.24	0.7
Se, μg/L	105.80	41.71	108.50	34.79	0.3
Mn, μg/L	2.40	4.72	2.05	3.20	0.4
Ba, μg/L	3.06	8.68	1.90	5.67	0.1

¹This number is for all parameters included in the table, except certain parameters as follows: Glucose [n = 126 (57%) for males, and n = 93 (42.1%) for females], blood urea nitrogen [n = 63 (28.5%) for males, and n = 52 (23.5%) for females], iron and zinc/iron ratio [n = 92 (41.6%) for males], manganese [n = 63 (28.5%) for males, and n = 42 (19%) for females], barium [n = 73 (33%) for males, and n = 56 (25.3%) for females].

The statistical analysis was conducted using the independent-samples Mann-Whitney U test, a nonparametric method. Interquartile range: A single number as a result of this mathematical equation (interquartile range = 75th percentile - 25th percentile). IQR: Interquartile range; BMI: Body mass index; HbA1c: Hemoglobin A1c; BP: Blood pressure; BUN: Blood urea nitrogen; Na: Sodium; K: Potassium; Ca: Calcium; Mg: Magnesium; Fe: Iron; Cu: Copper; Zn: Zinc; Se: Selenium; Mn: Manganese; Ba: Barium.

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Table 5 Comparative analysis of Hispanic and non-Hispanic subpopulations diagnosed with type 2 diabetes mellitus

Ethnicity	Hispanic (n = 109, 54.5%)¹		Non-Hispanic (n = 89, 44.5%)¹		P value
Ethnicity	Median	IQR	Median	IQR	P value
Age, years	15.44	2.95	15.32	2.78	0.66
Weight, kg	90.50	31.95	99.90	36.25	0.01
Height, cm	162.70	9.90	168.60	14.10	< 0.001
BMI, percentile	98.55	2.67	98.95	2.09	0.35
BMI Z-score	2.19	0.70	2.31	0.60	0.35
Systolic BP, mmHg	121.00	13.50	123.50	13.80	0.09
Diastolic BP, mmHg	69.00	13.50	68.50	11.50	0.19
Diabetes duration, years	2.03	2.68	2.01	3.07	0.99
HbA1c, percent	7.00	3.25	7.20	3.30	0.58
Glucose, mg/dL	118.00	115.50	124.00	95.50	0.54
BUN, mg/dL	11.00	3.75	10.00	4.50	0.14
Na, mg/dL	299.02	22.57	297.05	20.9	0.48
K, mg/dL	16.21	3.5	15.92	2.07	0.1
Mg, mg/dL	1.92	0.22	1.88	0.26	0.18
Ca, mg/dL	9.05	1.30	9.09	1.12	0.36
Fe, μg/dL	76.35	94.65	92.46	114.79	0.33
Cu, μg/dL	121.20	32.30	124.90	31.60	0.09
Zn, μg/dL	82.98	19.69	77.95	15.42	0.08
Zn/Fe ratio	1.08	1.19	0.86	1.16	0.32
Zn/Cu ratio	0.68	0.23	0.62	0.23	0.01
Se, μg/L	111.10	39.83	109.20	29.39	0.2
Mn, μg/L	1.42	3.47	2.89	5.52	0.01
Ba, μg/L	2.88	6.76	6.17	42.10	< 0.001

¹This number is for all parameters included in the table, except certain parameters as follows: Systolic blood pressure (non-Hispanic: n = 88, 44%), diastolic blood pressure (non-Hispanic: n = 88, 44%), diabetes duration (non-Hispanic: n = 87, 43.5%), blood urea nitrogen (Hispanic: n = 52, 26%; non-Hispanic: n = 45, 22.5%), manganese (Hispanic: n = 55, 27.5%; non-Hispanic: n = 52, 26%), barium (Hispanic: n = 75, 37.5%; non-Hispanic: n = 67, 33.5%).

The statistical analysis was conducted using the independent-samples Mann-Whitney test, a nonparametric method. Interquartile range: A single number as a result of this mathematical equation (interquartile range = 75th percentile - 25th percentile). IQR: Interquartile range; BMI: Body mass index; HbA1c: Hemoglobin A1c; BP: Blood pressure; BUN: Blood urea nitrogen; Na: Sodium; K: Potassium; Ca: Calcium; Mg: Magnesium; Fe: Iron; Cu: Copper; Zn: Zinc; Se: Selenium; Mn: Manganese; Ba: Barium.

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Table 6 Comparison between the male and female subpopulations within type 2 diabetes mellitus

Gender	Males (n = 69, 34.5%)¹		Females (n = 131, 65.5%)¹		P value
Gender	Median	IQR	Median	IQR	P value
Age, years	16.22	2.61	15.18	2.95	0.003
Weight, kg	105.10	34.00	87.90	28.20	< 0.0001
Height, cm	174.20	12.50	162.50	8.50	< 0.0001
BMI, percentile	99.23	1.71	98.46	2.48	0.002
BMI Z-score	2.42	0.65	2.16	0.59	0.002
Systolic BP, mmHg	127.00	12.00	119.00	14.30	0.00
Diastolic BP, mmHg	69.00	13.00	69.00	13.00	0.73
Diabetes duration, years	1.61	2.37	2.20	3.02	0.03
HbA1c, percent	7.10	3.25	7.10	3.00	0.52
Glucose, mg/dL	107.00	95.00	124.00	120.00	0.46
BUN, mg/dL	12.00	3.75	10.00	3.00	0.02
Na, mg/dL	301.67	16.91	296.04	23.22	0.02
K, mg/dL	16.11	2.32	16.06	2.71	0.84
Mg, mg/dL	1.92	0.19	1.87	0.24	0.05
Ca, mg/dL	9.35	1.21	8.96	1.21	0.02
Fe, μg/dL	92.46	83.04	73.86	124.62	0.23
Cu, μg/dL	121.50	36.04	122.90	32.80	0.01
Zn, μg/dL	82.57	18.74	78.38	19.23	0.01
Zn/Fe ratio	0.93	0.91	1.08	1.47	0.64
Zn/Cu ratio	0.69	0.29	0.63	0.23	0.001
Se, μg/L	109.70	32.69	109.70	37.79	0.98
Mn, μg/L	2.14	5.47	1.87	3.74	0.37
Ba, μg/L	3.59	9.57	5.10	12.77	0.79

¹This number is for all parameters included in the table, except certain parameters as follows: Systolic blood pressure (females: n = 130, 65%), diastolic blood pressure (females: n = 130, 65%), diabetes duration (males: n = 67, 33.5%; females: n = 127, 63.5%), blood urea nitrogen (males: n = 36, 18%; females: n = 62, 31%), manganese (males: n = 42, 21%; females: n = 65, 32.5%), barium (males: n = 52, 26%; females: n = 92, 46%).

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Table 7 Correlation analysis among children and adolescent patients with type 1 diabetes mellitus and type 2 diabetes mellitus, and the overall diabetic population

Diabetes type	T1DM HbA1c (%)		T2DM HbA1c (%)		Overall DM HbA1c (%)
Diabetes type	Spearman’s rho (ρ)	P value (2-tailed)	Spearman’s rho (ρ)	P value (2-tailed)	Spearman’s rho (ρ)	P value (2-tailed)
Age, years	0.17	0.01	0.08	0.27	-0.02	0.69
Weight, kg	0.12	0.08	-0.02	0.81	-0.16	0.001
Height, cm	0.11	0.1	0.02	0.82	-0.03	0.49
BMI, percentile	-0.09	0.17	-0.06	0.43	-0.22	< 0.0001
BMI Z-score	-0.09	0.17	-0.06	0.43	-0.22	< 0.0001
Systolic BP, mmHg	0.02	0.76	0.07	0.32	-0.08	0.09
Diastolic BP, mmHg	0.24	< 0.001	0.24	< 0.001	0.14	0.005
HbA1c, percent
Glucose, mg/dL	0.21	0.002	0.65	< 0.0001	0.49	< 0.0001
BUN, mg/dL	-0.08	0.38	0.21	0.04	0.12	0.08
Na, mg/dL	-0.11	0.11	-0.05	0.45	-0.06	0.24
K, mg/dL	0.04	0.53	0.05	0.49	0.06	0.21
Mg, mg/dL	-0.02	0.72	-0.2	0.004	-0.06	0.21
Ca, mg/dL	0.01	0.9	0.16	0.03	0.09	0.06
Fe, μg/dL	0.14	0.03	0.13	0.07	0.16	0.001
Cu, μg/dL	0.16	0.02	0.31	< 0.0001	0.17	0.001
Zn, μg/dL	-0.16	0.02	0.02	0.76	-0.09	0.07
Zn/Fe ratio	-0.19	0.01	-0.14	0.05	-0.19	0.0001
Zn/Cu ratio	-0.21	0.002	-0.23	0.001	-0.20	< 0.0001
Se, μg/L	0.06	0.38	0.18	0.01	0.13	0.01
Mn, μg/L	0.15	0.12	-0.02	0.83	0.04	0.59
Ba, μg/L	-0.03	0.74	-0.16	0.05	-0.15	0.01

T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; DM: Diabetes mellitus; HbA1c: Hemoglobin A1c; BMI: Body mass index; BP: Blood pressure; BUN: Blood urea nitrogen; Na: Sodium; K: Potassium; Ca: Calcium; Mg: Magnesium; Fe: Iron; Cu: Copper; Zn: Zinc; Se: Selenium; Mn: Manganese; Ba: Barium.

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Citation: Abdelbaset-Ismail A, Hui X, Lin Q, Gu C, Xu J, Watson S, Cai L, Tan Y, Wintergerst KA. Serum elemental profiles and their associations with glycemic control in pediatric type 1 and type 2 diabetes. World J Diabetes 2026; 17(8): 122649
URL: https://www.wjgnet.com/1948-9358/full/v17/i8/122649.htm
DOI: https://dx.doi.org/10.4239/wjd.122649

Abdelbaset-Ismail A, Hui X, Lin Q, Gu C, Xu J, Watson S, Cai L, Tan Y, Wintergerst KA. Serum elemental profiles and their associations with glycemic control in pediatric type 1 and type 2 diabetes. World J Diabetes 2026; 17(8): 122649 [DOI: 10.4239/wjd.122649]

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