Growth Patterns and Factors Associated with Short Stature in Saudi Children and Adolescents with Type 1 Diabetes...

Background: The impact of Type 1 Diabetes Mellitus (T1DM) on linear growth in children remains unclear, with conflicting evidence regarding the roles of glycemic control, disease duration, and nutritional factors. This study aimed to assess growth patterns and identify factors independently associated with short stature among Saudi school-age children and adolescents with T1DM, comparing them to a healthy control group. Methods: A retrospective cross-sectional study was conducted at an endocrinology clinic, including 250 patients with T1DM aged 5-18 years and 267 healthy controls. After propensity score matching, 231 patients were matched to 231 controls. Data were extracted from electronic medical records using a standardized form. Anthropometric measurements were converted to Z-scores and percentiles using validated Saudi growth charts. Short stature was defined as height below the third percentile for age and gender. Univariate and multivariable logistic regression analyses were performed to identify factors associated with short stature among T1DM participants. Results: The median age of the 250 T1DM participants was 13.0 [10.0-15.0] years, with a slight male predominance (58.0%). Of them, 6 (2.4%) children were tall, 30 (12.0% were short), and 214 (85.6%) were normal. A significantly higher proportion of short stature was observed in the T1DM group compared with the control group (6.1% vs. 1.7%; p = 0.016). Among T1DM participants, the proportion of short stature increased progressively with diabetes duration: 3.0% in new-onset disease, 14.9% in intermediate duration (2-5 years), and 25.0% in long-standing disease (>5 years) (p = 0.001). Age at onset of T1DM was also significantly associated with having short stature (p = 0.036). In multivariable analysis, intermediate duration (adjusted odds ratio [aOR] = 5.72, 95% CI (1.02-32.1); p = 0.047) and long-standing duration (aOR = 11.03, 95% CI: (1.09-111.45); p = 0.042) remained significant independent predictors of short stature. In contrast, glycemic control (HbA1c), vitamin D status, time in range, and treatment adherence were not significantly associated with short stature after adjustment. Conclusions: Children and adolescents with T1DM have significantly lower height percentiles and a higher prevalence of short stature compared to their controls. Diabetes duration is a strong, independent predictor of short stature in this population, with progressively higher risk as disease duration lengthens, regardless of glycemic control status. These findings underscore the necessity of systematic longitudinal growth monitoring, particularly in patients with disease duration exceeding five years, to enable early identification and intervention for those at highest risk of growth impairment.