Original articleGrowth, puberty, and final height in children with Type 1 diabetes
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.
References (48)
- et al.
Final height attainment in girls and boys with insulin-dependent diabetes mellitus
Diabetes Research and Clinical Practice
(1994) - et al.
Sex differences in the growth of diabetic children
Diabetes Research and Clinical Practice
(2000) Growth and normal puberty
Pediatrics
(1998)- et al.
Pubertal growth in IDDM is determined by HbA1c levels, sex, and bone age
Diabetes Care
(1998) - et al.
Elevated leptin levels are associated with excess gain in fat mass in girls, but not boys, with type 1 diabetes: Longitudinal study during adolescence
Journal of Clinical Endocrinology and Metabolism
(2001) - et al.
Sexual dimorphism in insulin sensitivity in adolescents with insulin-dependent diabetes mellitus
Journal of Clinical Endocrinology and Metabolism
(1991) - et al.
Age of menarche of schoolgirls in Khartoum, Sudan
Annals of Human Biology
(1983) - et al.
Growth changes in children and adolescents with short-term diabetes
Diabetes Care
(1998) - et al.
Growth during childhood and final height in type 1 diabetes
Diabetic Medicine
(1994) - et al.
Linear growth and weight gain in diabetic children: A cross-sectional and longitudinal evaluation
Journal of Pediatric Endocrinology & Metabolism
(2000)