Original article
Growth, puberty, and final height in children with Type 1 diabetes

https://doi.org/10.1016/j.jdiacomp.2005.07.001Get rights and content

Abstract

Objective

The aims of this study were to assess the physical growth and pubertal development in a group of diabetic children and to evaluate the effect of height at diagnosis, duration of illness, and degree of glycemic control on final height and sexual maturation.

Research design

A cohort of 72 Sudanese diabetic children, 7–13 years of age at diagnosis, was followed longitudinally from the onset of diabetes until the attainment of final height.

Results

The mean height standard deviation scores (SDS) at diagnosis were 0.04 in boys and −0.15 in girls, which was greater than their genetic target height (GTH). The growth velocity between diagnosis and final height was slow, with significant reduction in pubertal growth spurt. The mean final height attained by these children was lower than their GTH, a finding that contradicts most of the recently published reports. The average age at menarche in girls (15.1 years) and the mean age of full sexual maturation in boys (17.2 years) were significantly delayed in this group of diabetic patients. This retardation in physical growth and pubertal development was positively correlated with the duration of diabetes before the onset of puberty and glycated haemoglobin (HbA1c) concentration. The majority of these patients were thin at diagnosis of diabetes, with median body mass index (BMI) <22, but showed a remarkable, progressive weight gain during puberty, which was more evident in girls. The weight gain was independent of weight at diagnosis and duration of diabetes, but was positively correlated with the daily dose of insulin and HbA1c concentration.

Conclusion

Conventional therapy of diabetic children is associated with impairment of physical growth and delayed sexual maturation.

Introduction

In the past decade, the advancement in knowledge and the introduction of modern therapeutic regimens have generally improved the quality of care offered to the diabetic patients all over the world. In the industrialised countries, the classical diabetic dwarfism known to be associated with poorly controlled childhood diabetes mellitus (Mauriac syndrome) has now virtually disappeared. However, impairment of linear growth and pubertal development continue to be common complications of Type 1 diabetes mellitus in children and adolescents in many parts of the world (Danne et al., 1997, Donaghue et al., 2003, Du Caju et al., 1995). Although there are several reports on growth problems of diabetic children, only few studies have focused on sexual development and final height (Brown et al., 1994, Clarson et al., 1985, Penfold et al., 1995). It is still unclear whether these parameters are influenced by the duration of diabetes and the tightness of metabolic control alone or by some other additional factors (Herber & Dunsmor, 1988, Jivani & Rayner, 1973, Zachrisson et al., 1997). No published data are available on the growth of African diabetic children. This communication describes the progression of growth and sexual maturation in a group of Sudanese children with Type 1 diabetes followed longitudinally to final height and evaluates the effects of height at diagnosis, duration of the disease, and degree of glycemic control on that natural process.

Section snippets

Participants and research methods

The study population was identified from the regular attendants of the diabetes clinic of the university hospital in Khartoum, Northern Sudan, after they and their parents had given an informed consent. The incidence of Type 1 diabetes in children 0–15 years of age in Khartoum is 10.1/100, and about 150 new cases are diagnosed each year, as we have documented before (Elamin, Omer, Zein, & Tuvemo, 1992). Inclusion criteria were age between 7 and 13 years at diagnosis and absence of other medical

Results

The clinical characteristics of the patients and the data of their physical growth and pubertal development are summarised in Table 1. The average duration of diabetes before the onset of puberty was 5 years, and the median HbA1c concentration during puberty was 9.8%. The median insulin dose required to control blood glucose levels during pubertal years was 1.4 U/kg/day.

In the majority of patients, the growth velocity decelerates within the first year of diagnosis and continued below the

Discussion

The question of whether linear growth and sexual maturation are impaired in diabetic children is still debated. Several papers have documented retarded growth and delayed puberty with Type 1 diabetes even in reasonably controlled patients (Ahmed et al., 1998, Choudhury & Stutchfield, 2000, Lebl et al., 2003, Salerno et al., 1997), while many other studies found no effect of diabetes on growth and sexual maturation (D' Annunzio et al., 1994, Jos et al., 1996, Pitukcheewanont et al., 1995).

Acknowledgments

This study was supported by grant from in-develops U-lands fond, Uppsala University, Sweden.

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