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The relationship of metabolic control to growth and pubertal development in children with insulin-dependent diabetes
Insights
Children with insulin-dependent diabetes mellitus (IDDM) showed normal growth and pubertal development. Diabetic control, indicated by HbA1 levels, did not significantly impact their growth patterns.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Children with Insulin-Dependent Diabetes Mellitus (IDDM) often face challenges in growth and pubertal development.
- Understanding the factors influencing these outcomes is crucial for long-term health.
- Glycemic control, measured by HbA1 levels, is a key area of interest.
Purpose of the Study:
- To investigate the relationship between diabetic control and growth/pubertal development in children with IDDM.
- To assess height, weight, and pubertal progression in a cohort of pediatric IDDM patients.
- To determine if HbA1 levels correlate with growth velocity or final stature.
Main Methods:
- Longitudinal study of 122 children with IDDM (mean age 13.4 years).
- Regular measurements of height, weight, pubertal status, insulin dosage, and HbA1 over at least one year.
- Statistical analysis to compare growth percentiles and correlate with HbA1 levels.
Main Results:
- Normal height and height velocity percentiles observed in both boys and girls.
- Boys showed an increased mean weight percentile, but weight velocity was normal for both sexes.
- Pubertal development, including age of Tanner stage 2 and menarche, was within normal ranges.
- Mean HbA1 levels were elevated (11.1%) but showed no significant correlation with height or weight velocity or percentiles.
Conclusions:
- Diabetic control, as reflected by HbA1 levels, was not a primary determinant of growth in this IDDM cohort.
- Children with IDDM demonstrated normal growth and pubertal development despite a wide range of glycemic control.
- Normal growth may indicate "average" metabolic control rather than optimal control in pediatric IDDM.
Abstract:
Growth and pubertal development were studied in 122 children aged 13.4 +/- 2.9 yr (mean +/- SD) with IDDM of 6.1 +/- 3.8 yr duration. Height and weight, pubertal status, insulin dose (u/kg), frequency of insulin administration and HbA1 were measured every 3 months for a minimum period of 1 yr for each child. The mean and distribution of height and height velocity percentiles were normal for boys and girls. The mean weight percentile for boys was increased (62 +/- 27, p less than 0.01), but was normal for girls. The mean and distribution of weight velocity percentiles were normal for both sexes. The mean and distribution of age of onset of Tanner 2 in both boys (11.9 +/- 1.4 yr) and girls (11.2 +/- 1.3) was normal, as was the age of menarche (13.2 +/- 1.2 yr). The mean HbA1 level was 11.1 +/- 2.0% (normal less than 7.5%). There was no correlation of mean HbA1 levels (calculated from 4 or more measurements for each child) with height velocity or with weight velocity percentiles or with mean height or weight percentiles. These results indicate that diabetic control, as reflected by HbA1 levels, was not a major determinant of growth in this group of children with IDDM, who displayed normal growth patterns and pubertal development despite a wide range of HbA1 levels. Normal growth may not reflect optimal metabolic control but "average" control.