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[Growth of children with insulin-dependent diabetes. Study of 104 cases]
1Département de pédiatrie, hôpital et faculté Necker-Enfants Malades, Paris, France.
Insights
Children with diabetes mellitus may experience growth loss, particularly with early onset, poor metabolic control, and during puberty. Factors like insulin dosage and weight significantly impact growth trajectories in diabetic children.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth and Development
Context:
- Conflicting results exist regarding growth patterns in children with diabetes mellitus.
- Statural growth in diabetic children requires detailed analysis to understand influencing factors.
Purpose:
- To analyze statural growth in a sample of diabetic children using cross-sectional and longitudinal methods.
- To identify characteristics of growth and their relationship with various factors in pediatric diabetes.
Summary:
- Diabetic children's height did not differ at diagnosis, but boys were taller pre-diagnosis. Post-diagnosis, children became overweight. A progressive decrease in growth velocity was observed starting before diabetes onset and continuing until growth completion.
- Significant growth loss occurred from diagnosis to final height. Early-onset diabetes, poor metabolic control (correlated with Hemoglobin A1c), and puberty onset exacerbated growth alterations.
- Adolescent girls experienced reduced growth spurts, especially when overweight with insufficient insulin. Overall, diabetic children grew within the normal range, but adverse effects were linked to early onset, disease duration, and metabolic control.
Impact:
- Findings highlight the critical impact of diabetes management on long-term growth outcomes in children.
- Identifies key factors (early onset, metabolic control, puberty, weight, insulin dosage) influencing growth, informing clinical practice.
- Provides insights for optimizing growth monitoring and therapeutic strategies in pediatric diabetes management.
Background:
Results of studies of growth in children with diabetes mellitus are still conflicting. In a cross-sectional and longitudinal study, statural growth was analysed in a sample of diabetic children in order to specify its characteristics and relationship with various factors.
Population And Methods:
One hundred and four children (53 girls and 51 boys) with insulin-dependent diabetes for more than 3 years have been studied (age at onset and duration of diabetes, respectively, 6.4 +/- 4.1 and 8.5 +/- 4.8 in girls; 6.1 +/- 3.9 and 7.9 +/- 3.9 in boys; m +/- SD). A control group included 51 boys (age: 8.9 +/- 2.9) and 49 girls (age: 9.3 +/- 2.7). Data were collected every three months. Hemoglobin A1c was measured using high performance liquid chromatography (normal range: 5.0 +/- 1.0%; m +/- 2 DS).
Results:
At diagnosis, height (evaluated in SD) did not differ between diabetic children and controls. Three years before the onset of diabetes, boys were taller compared to controls (1.02 +/- 0.20 vs 0.41 +/- 0.17; P < 0.05; m +/- SEM). Children five years after the onset of disease were overweight compared to controls (girls: 0.96 +/- 0.16 vs 0.00 +/- 0.20; boys: 0.59 +/- 0.16 vs -0.04 +/- 0.15; P < 0.01; m +/- SEM). Longitudinal study showed a progressive decrease of mean growth velocity starting at least 2 years before the onset of diabetes and proceeding until the end of growth. From diagnosis to the end of height development, there was a growth loss of 0.66 SD in girls (p < 0.01) and 0.69 SD in boys (p < 0.05). This alteration of growth affected more clearly children who became diabetic before the onset of puberty, especially those with early-onset diabetes and bad metabolic control. Growth changes for the first 5 years of diabetes were significantly and negatively correlated with mean hemoglobin A1c levels (r = -0.57). Growth changes from the onset of diabetes to the end of growth were correlated with age at diagnosis, (boys: r = 0.73; girls: r = 0.37). During puberty, girls exhibited a reduced growth spurt, especially when they were overweight and received too low doses of insulin.
Conclusions:
On the whole, diabetic children were growing in normal range. Growth was adversely and mainly affected by early-onset diabetes, a long duration of disease, many years of poor metabolic control and, especially in adolescent girls, low doses of insulin and weight excess.