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Hypercalciuria, hyperphosphaturia, and growth retardation in children with diabetes mellitus
Insights
Children with diabetes mellitus often experience growth retardation. Renal losses of calcium and phosphorus, linked to glucosuria, significantly impact their height more than hyperglycemia alone.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Nephrology
Background:
- Children with diabetes mellitus (DM) frequently exhibit growth retardation compared to their healthy peers.
- Investigating the specific factors contributing to poor growth in pediatric DM is crucial for effective management.
Observation:
- A cross-sectional study assessed 157 children with DM and 37 non-diabetic siblings.
- Children with DM showed significantly reduced mean height.
- Hyperglycemia, hypercalciuria, and hyperphosphaturia were measured alongside height.
Findings:
- The duration of diabetes (hyperglycemia) negatively correlated with height, with significant differences emerging after 7 years.
- Hypercalciuria and hyperphosphaturia were more strongly associated with reduced height than hyperglycemia.
- Renal wasting of calcium and phosphorus appeared secondary to glucosuria.
Implications:
- Hypercalciuria and hyperphosphaturia, known growth inhibitors in non-diabetic children, likely contribute significantly to poor growth in pediatric DM.
- Understanding these renal mechanisms may lead to targeted interventions to improve growth outcomes in children with diabetes.
Abstract:
The role of hypercalciuria and hyperphosphaturia in the growth retardation of children with diabetes mellitus was investigated in 157 children with diabetes whose mean height was less than that of 37 nondiabetic siblings of similar age (P less than .025). Hyperglycemia, hypercalciuria, and hyperphosphaturia were assessed coincident with the height measurement of each child in a cross-sectional survey. The distribution of height percentiles of the children with diabetes was skewed to the left with 61% at or below the 50th percentile. Eleven percent of the insulin-dependent children with diabetes mellitus were shorter than would be anticipated by a normal distribution of the 157 children. The duration of diabetes (hyperglycemia) had the greatest influence upon the children's height. Children with diabetes were shorter than the nondiabetic subjects by the fourth year of hyperglycemia, and this difference in height became statistically significant after 7 years or more of diabetes. The degree of hypercalciuria and hyperphosphaturia was more closely associated with reduced height in children with diabetes than was the degree of hyperglycemia, although the renal wastage of calcium and phosphorus seemed to be the result of glucosuria. Because hypercalciuria and hyperphosphaturia impair growth in nondiabetic children, they may also play an important role in the poor growth of children with diabetes mellitus.
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