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Longitudinal analysis of somatic development in paediatric patients with IDDM: genetic influences on height and
R W Holl1, E Heinze, M Seifert
1Department of Paediatrics I, University Children's Hospital, Ulm, Germany.
Insights
Children with insulin-dependent diabetes mellitus (IDDM) experience temporary growth reduction and delayed maturation, but genetic factors are more influential on height. Diabetic children tend to be overweight, increasing future cardiovascular risks.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth and Development
Background:
- Managing growth and preventing overweight are crucial in pediatric diabetes care.
- Insulin-dependent diabetes mellitus (IDDM) requires careful monitoring of developmental parameters.
Purpose of the Study:
- To longitudinally assess anthropometric measurements (height, weight) and bone age in children with IDDM.
- To investigate genetic influences on growth parameters by including unaffected siblings and parents.
- To evaluate the long-term impact of IDDM on growth and weight development.
Main Methods:
- Longitudinal evaluation of height, weight, and bone age in 389 pediatric IDDM patients.
- Inclusion of 186 unaffected siblings and 177 parent pairs to assess genetic factors.
- Comparison of anthropometric data between diabetic patients and their unaffected relatives.
Main Results:
- Patients with IDDM were slightly taller at diagnosis but showed progressive decreases in height and delayed bone age during the first 9 years of diabetes.
- Height normalized after 10 years, with final height not differing significantly from unaffected siblings, indicating strong genetic influence.
- Diabetic children were significantly heavier than unaffected siblings, with obesity developing primarily during and after puberty.
Conclusions:
- Diabetes temporarily reduces longitudinal growth and delays maturation in children, but these effects are transient and less significant than genetic height influences.
- As a group, children with IDDM are prone to becoming overweight, potentially elevating cardiovascular risk in adulthood.
Abstract:
Normal growth and development, as well as the prevention of overweight, are major goals in the treatment of paediatric patients with insulin-dependent diabetes mellitus (IDDM). We therefore evaluated longitudinally the anthropometric measurements of height and weight, as well as bone age, in an unselected group of 389 patients with IDDM treated at one institution. In order to identify genetic influences on these parameters, height and weight were determined in 186 unaffected siblings and 177 pairs of parents. At diagnosis, patients were slightly taller than average (median z score: +0.37). During the subsequent course of diabetes, age-adjusted heights decreased progressively for the first 9 years, catching up again after more than 10 years of diabetes. Bone ages were progressively retarded with increasing duration of diabetes. In 76 patients of 18 years or older, median z-score for height was +0.30, not different from their unaffected siblings (median z-score: +0.22). The correlation with midparental height was identical for diabetic and nondiabetic siblings (r = 0.43). In contrast, children with diabetes were significantly heavier (z-score for weight: +0.74 compared to +0.34 in unaffected siblings; p < 0.002). Obesity developed primarily during and after puberty. We conclude that: 1) during the course of diabetes, longitudinal growth is temporarily reduced and maturation is delayed in children with diabetes compared to unaffected siblings. However, this effect of diabetes is transient and small compared to genetic influences on height in an individual child. 2) As a group, children with IDDM become significantly overweight, which is likely to increase the cardiovascular risk during adulthood.