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Growth and body composition in type 1 diabetes mellitus
David Dunger1, Lynn Ahmed, Ken Ong
1Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. dbd25@cam.ac.uk
Hormone Research
|October 10, 2002
Summary
Children with type 1 diabetes mellitus (T1DM) show improved growth, but subtle pubertal development issues persist. Intensified insulin therapy can lead to weight gain and hormonal changes, impacting long-term health outcomes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- Type 1 diabetes mellitus (T1DM) management has advanced, improving childhood growth and pubertal development.
- Early Mauriac's syndrome was linked to insulin deficiency and caloric restriction; modern approaches have improved outcomes but subtle issues remain.
- Children with T1DM face risks including hypothyroidism and celiac disease, alongside potential growth axis impairments.
Purpose of the Study:
- To analyze the long-term effects of type 1 diabetes mellitus on growth and pubertal development in children.
- To investigate persistent abnormalities in the GH/IGF-1 axis and their impact on pubertal growth, particularly in girls.
- To examine the consequences of intensified insulin therapy, including weight gain, hormonal changes, and associated health risks.
Main Methods:
- Review of historical and contemporary data on growth and pubertal development in children with T1DM.
- Analysis of hormonal profiles, including the GH/IGF-1 axis and sex steroids.
- Assessment of metabolic outcomes related to intensified insulin therapy and weight management.
Main Results:
- While overall growth has improved, subtle abnormalities in pubertal development persist in children with T1DM.
- Intensified insulin therapy can lead to increased fat mass, particularly in girls, potentially causing leptin resistance.
- Abnormalities in the GH/IGF-1 axis and sex steroids contribute to blunted pubertal growth in girls, with hyperinsulinaemia posing risks for complications.
Conclusions:
- Most children with T1DM achieve normal final heights, but persistent pubertal development issues require ongoing monitoring.
- Excessive weight gain in girls with T1DM may affect treatment compliance and increase risks of ovarian hyperandrogenism and microvascular complications.
- Long-term cardiovascular risk and early microvascular complications are heightened in individuals with T1DM, necessitating comprehensive management strategies.