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Published on: July 16, 2016
Residual β-cell mass influences growth of prepubertal children with type 1 diabetes
Carla Bizzarri1, Danila Benevento, Ippolita Patrizia Patera
1Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Type 1 diabetes (T1D) impacts child growth even with intensive insulin therapy. Preserving residual beta-cell function positively influences growth, independent of glycemic control quality.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Research
Background:
- Childhood growth deceleration is linked to type 1 diabetes (T1D) and poor glycemic control.
- The persistence of growth impairment despite optimized T1D therapy remains unclear.
- This study investigates the impact of intensive insulin treatment on prepubertal growth in children with T1D.
Purpose of the Study:
- To evaluate the long-term effects of intensive insulin therapy on the growth of prepubertal children with type 1 diabetes.
- To determine the relationship between residual beta-cell function, glycemic control, and growth outcomes in T1D.
- To assess if growth impairment persists in T1D children even with optimized treatment.
Main Methods:
- Longitudinal evaluation of 104 children with T1D from diagnosis to puberty onset.
- Regular monitoring of height, weight, insulin requirements, and glycated hemoglobin (HbA1c).
- Estimation of residual beta-cell mass using fasting C-peptide levels at T1D onset.
Main Results:
- Height SDS showed a slight but significant decrease from 0.52 at onset to 0.36 at follow-up (p=0.04).
- BMI SDS significantly increased from -0.04 to 0.32 (p=0.01).
- Height velocity was positively associated with C-peptide and insulin requirement, and inversely with HbA1c. BMI gain was negatively influenced by HbA1c.
Conclusions:
- Intensive insulin therapy does not fully prevent the negative impact of type 1 diabetes on prepubertal growth.
- Residual beta-cell mass plays a crucial role in promoting growth in T1D children.
- The positive effect of residual beta-cell function on growth is independent of glycemic control levels (HbA1c).
Background:
The growth deceleration observed in children with type 1 diabetes (T1D) has been related to poor glycemic control. It is unclear whether growth impairment persists despite the optimization of therapy. We analyzed the effects of intensive insulin treatment on prepubertal growth.
Methods:
One hundred and four T1D children were evaluated from T1D diagnosis up to puberty onset. Height, weight, insulin requirement and glycated hemoglobin (HbA1c) were recorded at 3- to 6-month intervals. Residual β-cell mass was estimated by fasting C-peptide at T1D onset.
Results:
Age at T1D onset was 5.91 ± 1.9 years. Follow-up duration was 4.84 ± 1.58 years. Height velocity standard deviation score (SDS) was -0.14 ± 1.84. Height SDS changed from 0.52 ± 1.04 at T1D onset, to 0.36 ± 1.10 at the end of follow-up (p = 0.04). BMI SDS increased from -0.04 ± 1.48 to 0.32 ± 1.03 (p = 0.01). Multivariate analysis showed that height velocity was directly affected by C-peptide (p = 0.03) and insulin requirement (p = 0.004) and inversely related to HbA1c (p = 0.006). BMI gain was negatively influenced by HbA1c (p = 0.01) and positively related to T1D duration (p = 0.01).
Conclusion:
Despite insulin intensive therapy, T1D still negatively affects growth. Residual β-cell mass has a direct positive impact on growth, independently from the quality of glycemic control.
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