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Determinants of growth in diabetic pubertal subjects
I Zachrisson1, K Brismar, K Hall
1Department of Pediatrics, Danderyd Hospital, Sweden. ingmar.zachrisson@bar.ds.sll.se
Insights
In well-controlled diabetic children, insulin growth factor (IGF-I) levels during puberty are lower than normal. However, adequate insulin therapy ensures normal growth and final height achievement in these children.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth and Development
Background:
- Pubertal growth is influenced by hormonal changes, including Insulin-like Growth Factor-I (IGF-I).
- Diabetes mellitus can affect pubertal development and growth patterns.
Purpose of the Study:
- To investigate the relationship between metabolic control, IGF-I levels, and growth rate in pubertal children with diabetes.
- To analyze the impact of factors like HbA1c, insulin dose, and dehydroepiandrosterone sulfate (DHEAS) on IGF-I and growth.
Main Methods:
- Studied 72 diabetic children across different pubertal stages.
- Measured IGF-I, IGF-I SD score, IGF binding protein (BP)-1, and growth rate.
- Analyzed correlations with age, sex, weight/length index, HbA1c, insulin concentration, insulin dose, and DHEAS.
Main Results:
- IGF-I levels peaked in Tanner stage 4, with IGFBP-1 showing an inverse pattern.
- IGF-I SD score deviations increased with pubertal stage in boys.
- HbA1c, insulin dose, and DHEAS correlated with IGF-I SD score; DHEAS and IGF-I SD score correlated with growth rate.
Conclusions:
- Diabetic children with good metabolic control exhibit blunted IGF-I increase during puberty.
- Adequate exogenous insulin therapy is crucial for achieving normal IGF-I bioavailability and target final height.
- Sufficient insulin compensation is vital for supporting rapid linear growth in diabetic adolescents.
Objective:
To analyze the relationship among metabolic control, IGF-I, and growth in pubertal diabetic subjects.
Research Design And Methods:
In 72 diabetic children, we have studied the pattern of change of IGF-I, IGF-I SD score, IGF binding protein (BP)-1, and growth rate in different pubertal stages and have analyzed their relation to age sex, weight/length index, HbA1c, insulin concentration, insulin dose, and dehydroepiandrosteronesulfate (DHEAS).
Results:
The serum IGF-I values increased up to Tanner stage 4 and thereafter decreased, whereas IGFBP-1 showed the inverse pattern. When transforming the IGF-I values into SD scores, correcting for age, sex, and pubertal stage, it was shown that the deviation from normal values increased with increasing pubertal stage in boys, but was equal in stages 3-5 in girls. Using multiple regression analysis, HbA1c, insulin dose, and DHEAS were significantly correlated to IGF-I SD score (R2 = 0.253, P = 0.001). IGFBP-I levels in the afternoon were within normal range. LogIGFBP-1 showed an inverse correlation, to insulin concentration in single correlation (r = -0.26, P = 0.02). In single correlation, growth rate correlated significantly to insulin dose (r = 0.25, P = 0.03). In a multiple regression analysis, only DHEAS and IGF-I SD score were found to be significantly correlated to growth rate (R2 = 0.370, P < 0.001). The 18 adolescents who had reached their final height did not deviate from their target final height, according to their recorded growth since birth.
Conclusions:
In a group of fairly well-controlled diabetic children, the normal increase in IGF-I during puberty is blunted. Despite decreased IGF-I levels, target final height was attained, probably because of adequate insulin compensation leading to normal IGFBP-l, thus adequate bioavailability of IGF-I. Our results point out the importance of sufficient exogenous insulin in the period of rapid linear growth.