Trace elements in relation to glycemic control and disease complications in children living with type 1 diabetes mellitus

Trace elements such as copper, zinc and magnesium are essential for antioxidant defence, insulin action and glucose homeostasis, yet their clinical utility as biomarkers in childhood type 1 diabetes mellitus remains uncertain. We conducted a case–control study of 199 Egyptian children aged 5–18 years (100 with type 1 diabetes mellitus and 99 non-diabetic controls) attending the National Nutrition Center. Anthropometry, lifestyle characteristics and biochemistry were assessed, and serum copper, zinc and magnesium were measured by atomic absorption; the copper to zinc ratio was calculated. Children with type 1 diabetes mellitus had significantly lower zinc and magnesium concentrations and higher copper to zinc ratios than controls, while mean copper levels did not differ significantly. Lower magnesium and zinc, higher body mass index, elevated triglycerides and reduced physical activity were independently associated with type 1 diabetes mellitus. In receiver operating characteristic analyses, magnesium showed the best discriminative performance between diabetic and control children, whereas zinc and the copper to zinc ratio were highly specific markers of poor glycaemic control, and zinc deficiency and reduced estimated glomerular filtration rate were consistently associated with microvascular complications. These findings support trace-element monitoring to refine risk stratification and management in pediatric type 1 diabetes mellitus.