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Effect of glycemic control on growth velocity in children with IDDM
J E Wise1, E L Kolb, S E Sauder
1Department of Pediatrics, University of Illinois, College of Medicine, Peoria, Illinois.
Insights
Maintaining good glycemic control is crucial for growth in children with insulin-dependent diabetes mellitus. Poorly controlled diabetes, indicated by high glycosylated hemoglobin (GHb), can significantly slow growth, especially in younger children.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Insulin-dependent diabetes mellitus (IDDM) affects children's growth.
- Glycemic control is a key factor in managing IDDM.
Purpose of the Study:
- To investigate the relationship between glycemic control and growth velocity in children with IDDM.
- To identify specific glycemic thresholds for growth suppression based on pubertal status.
Main Methods:
- A longitudinal study of 122 children with IDDM over 5 years.
- Regular assessment of glycosylated hemoglobin (GHb) for glycemic control.
- Measurement of height and calculation of growth velocity using tau scores (delta tau).
Main Results:
- A significant inverse linear relationship was observed between GHb levels and growth velocity (r = -0.117, P = 0.001).
- GHb levels below 8% correlated with growth acceleration, while levels above 16% were associated with the greatest growth deceleration.
- The threshold for growth suppression varied by pubertal status, with prepubertal children being most vulnerable.
Conclusions:
- Linear growth velocity in children with IDDM is strongly influenced by metabolic control.
- Prepubertal and early pubertal children are most susceptible to growth suppression due to hyperglycemia.
- Significant hyperglycemia (GHb > 16%) is required to suppress growth once puberty is well-established.
Objective:
To determine the effect of glycemic control on growth velocity in children with insulin-dependent diabetes mellitus.
Research Design And Methods:
One hundred twenty-two children with insulin-dependent diabetes mellitus were studied over a 5-yr period. Every 4 mo, glycemic control was assessed by measuring total glycosylated hemoglobin (GHb), pubertal status was determined by physical examination, and height was measured with a stadiometer. Height measurements were normalized for age and sex by converting them to tau scores (the number of SD above or below the mean for age and sex). Alterations in growth velocity were determined by the change in tau scores (delta tau) between visits (i.e., no change in tau score = normal growth velocity; decrease in tau score = growth deceleration; and increase in tau score = growth acceleration).
Results:
A linear relationship was seen between GHb levels and the change in tau scores (r = -0.117, P = 0.001). GHb values less than 8% were associated with growth acceleration (delta tau = +0.10 +/- 0.03), and the greatest growth deceleration occurred when GHb was greater than 16% (delta tau = -0.07 +/- 0.03). The level of GHb at which growth suppression occurred (mean delta tau became negative) was dependent on pubertal status: Tanner stage 1 greater than or equal to 10%, Tanner stages 2 and 3 greater than or equal to 8%, Tanner stages 4 and 5 greater than or equal to 16%.
Conclusions:
Linear growth velocity in children with insulin-dependent diabetes mellitus is heavily related to metabolic control. Children who are prepubertal or in the early stages of puberty are the most vulnerable to growth suppression. Once puberty is well established, growth suppression does not occur until marked hyperglycemia (GHb greater than 16%) exists.