Sex differences in the growth of diabetic children

Final height in children and adolescents with type 1 diabetes mellitus: A systematic review and meta-analysis

PURPOSE

Considering the high prevalence of type 1 diabetes mellitus (T1DM) together with the importance of improved physical growth and the significance of promoting healthcare quality among T1DM children, this meta-analysis aims to determine mean final height in this population group.

METHODS

We systematically searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane databases for all studies published until May 2023 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size (mean final height Z-score) among T1DM children in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated. The included studies consisted of data from 3274 patients.

RESULTS

The mean final height Z-score for T1DM children was -0.201 (n = 25 studies, 95% CI: -0.389, -0.013; I2 = 97%), -0.262 in males (n = 20 studies, 95% CI: -0.539, 0.015, I2 = 97.1%), and -0.218 in females (n = 18 studies, 95% CI: -0.436, 0, I2 = 94.2%). The non-significant negative association between age at diagnosis, HbA1c levels, and final height Z-score is suggested by the findings of the univariate meta-regression.

CONCLUSION

Our findings indicated that children with T1DM have impaired linear growth and that monitoring of growth in these patient populations is an important issue in the management of T1DM. Due to a scarcity of studies providing data on the relationship between uncontrolled diabetes (increased HbA1c) and early diagnosis and final height, further investigation is warranted to determine whether there is indeed a correlation. Consequently, any conclusion regarding the association between uncontrolled diabetes (elevated HbA1c), early diagnosis of T1DM, and the increased risk of impaired linear growth or final height remains uncertain.

Linear Growth in Children and Adolescents with Type 1 Diabetes Mellitus

Ensuring normal linear growth is one of the major therapeutic aims in the management of type one diabetes mellitus (T1DM) in children and adolescents. Many studies in the literature have shown that pediatric patients with T1DM frequently present some abnormalities in their growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis compared to their healthy peers. Data on the growth of T1DM children and adolescents are still discordant: Some studies have reported that T1DM populations, especially those whose diabetes began in early childhood, are taller than healthy pediatric populations at diagnosis, while other studies have not found any difference. Moreover, many reports have highlighted a growth impairment in T1DM patients of prepubertal and pubertal age, and this impairment seems to be influenced by suboptimal glycemic control and disease duration. However, the most recent data showed that children treated with modern intensive insulin therapies reach a normal final adult height. This narrative review aims to provide current knowledge regarding linear growth in children and adolescents with T1DM. Currently, the choice of the most appropriate therapeutic regimen to achieve a good insulin level and the best metabolic control for each patient, together with the regular measurement of growth parameters, remains the most important available tool for a pediatric diabetologist. Nevertheless, since new technologies are the therapy of choice in young children, especially those of pre-school age, it would be of great interest to evaluate their effects on the growth pattern of children with T1DM.

The influence of treatment, age at onset, and metabolic control on height in children and adolescents with type 1 diabetes-A SWEET collaborative study

OBJECTIVE

To describe the association between height, demographics, and treatment in youths with type 1 diabetes participating in an international network for pediatric diabetes centers (SWEET).

METHODS

Data were collected from 55 centers with documented patients' height. All subjects below 20 years of age, diabetes duration >1 year, and without celiac disease were included. World Health Organization growth charts were used to calculate height and body mass index z-scores. Multiple hierarchic regression models adjusting for known confounders were applied.

RESULTS

Data on 22 941 subjects (51.8% male) were analyzed with a median and interquartile range for age 14.8 years (11.2, 17.6), diabetes duration 5.6 years (3.1, 8.9), and height z-score 0.34 (-0.37, 1.03). Children were taller in the youngest age groups: adjusted height z-scores of 0.31 (±0.06) and 0.39 (±0.06), respectively; with shorter diabetes duration (<2 years: 0.36 [±0.06]; 2-<5 years: 0.34 [±0.06]; ≥5 years: 0.21 [±0.06]) and if they were pump users: 0.35 ± 0.05 vs 0.25 ± 0.05 (>three injections/day and 0.19 ± 0.06 [0-3 injections daily]), respectively. High hemoglobin A1c (HbA1c) and low to normal weight were associated with a lower height z-score. Trends were identical in all models except for gender. No gender differences were found except in the final height model where females exhibited higher z-score than males.

CONCLUSION

For youths treated at centers offering modern diabetes management, major growth disturbances are virtually eliminated. For children with a young age at onset, high HbA1c, injections, and/or non-intensive diabetes, treatment still requires attention in order to attain normal growth.

The association of insulin-like growth factor-1 standard deviation score and height in Chinese children with type 1 diabetes mellitus

Assessing the relationship between IGF-1 and height in type 1 diabetes children. Seventy-two type 1 diabetes children and 190 controls were recruited. The height standard deviation score of type 1 diabetes children was significantly higher than controls. The height standard deviation score was higher than the target height standard deviation score in both type 1 diabetes and controls. Serum IGF-1 levels and the IGF-1 standard deviation score were significantly lower in type 1 diabetes patients compared with controls. There was a significant difference in IGF-1 standard deviation score between the good glycemic control group and control group. The height standard deviation score was significantly correlated with C-peptide and IGF-1 levels. Furthermore, the IGF-1 standard deviation score was significantly correlated with glycemic control and C-peptide. The growth hormone/IGF-1 axis is impaired in type 1 diabetes, but height with good or poor glycemic control is not impaired.

Growth attainments of Indian children with type 1 diabetes: a mixed longitudinal study

OBJECTIVE

To evaluate distance and velocity growth of children with Type 1 Diabetes (T1D) and quantify the magnitude of gender differences in anthropometric parameters.

METHODS

Children with T1D, without any coexisting condition that could affect growth were measured at half yearly intervals for body weight, height, occipito-frontal circumference (OFC), chest circumference (CC), mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT), biceps skinfold thickness (BSFT) and subscapular skinfold thickness (SSSFT) using standardized techniques. Comparison of these growth parameters was made between the 2 genders as well as with the published norms.

RESULTS

Of the 115 children studied, there were no significant gender differences in weight at different age points. Boys measured taller than girls but the gender differences in height were significant only at 7 and 10 y. There was a tendency of higher BMIs in girls. In comparison to WHO standards and normal Indian children, boys had lower weight initially but became heavier later. The girls showed close similarity to their normal Indian counterparts but remained lighter than their WHO counterparts. After the initial lower height, an acceleratory trend was noted in boys but girls remained shorter throughout the study as compared to WHO peers. Boys, in general had higher CC, OFC, MUAC and MUAMC. The skinfold thicknesses recorded inconsistent growth patterns in both sexes. Growth velocities for various body parameters except skinfold thicknesses were similar in boys and girls.

CONCLUSIONS

Initial weight and height loss followed by catch up growth was noted in boys. The values of MUAC, MUAMC and skinfold thicknesses as compared to data from developed countries, were lower in present patients.

Physical Growth and Body Composition of Controlled Versus Uncontrolled Type 1 Egyptian Diabetic Children

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic endocrine disorders of childhood. Data on growth parameters of diabetic children is scarce.AIM: To assess growth and body composition in a group of diabetic children.SUBJECTS AND METHODS: 427 T1DM children (age 2-10 years) were recruited from Diabetic Paediatric Unit, outpatients' clinic of Abou El-Rish Hospital. Anthropometric and body composition parameters were taken and HbA1c was measured for all subjects.RESULTS:  Highly significant difference was detected between controlled and uncontrolled groups as regard to weight/age z-score, height/age z-score, BMI z-score, triceps skin fold thickness, subscapular skin fold thickness, midupper arm circumference, fat mass, fat %, lean mass, and body water (p < 0.001). All values are higher in the controlled group than in the uncontrolled group. Uncontrolled subjects were significantly more at risk of being underweight and short, with odds ratio of 15.131 and 16.877 and 95% confidence interval 1.972-116.130 and 3.973-71.694 respectively. However, controlled subjects were significantly more at risk of being obese than the uncontrolled with an odds ratio 0.116 and 95% confidence interval 0.045-0.302.CONCLUSION: Growth was compromised in uncontrolled T1DM children. This is of utmost importance since most of the clinical features are reversible with better glycemic control and appropriate insulin management.

Sexual dimorphism in growth and insulin-like growth factor-I in children with type 1 diabetes mellitus

OBJECTIVE

Impaired linear growth and reduced IGF-I levels in children with type 1 diabetes (T1DM) have been related to poor metabolic control. The aim of this study was to identify additional factors which may negatively affect growth and IGF system in patients with T1DM.

DESIGN

Ninety-one T1DM children (54 males, age=: 11.73±3years, disease duration=5.6±2.1years) were studied. All children were on intensive insulin therapy: 62 children were on multiple injection therapy (MI) and 29 children on continuous subcutaneous insulin infusion (CSII).

RESULTS

Height velocity (HV) SDS and IGF-I levels were higher in females and in pubertal children [HV SDS: females=0.6±2.4 vs males=-0.45±2.3 (p=0.04); IGF-I SDS: females=-1.09±0.58 vs males=-1.4±0.6 (p=0.02); IGF-I/IGFBP-3 molar ratio: females=0.25±0.1 vs males=0.21±0.08 (p=0.04); IGF-I SDS: pre-pubertal=-1.58±0.46 vs pubertal=-1.15±0.65 (p<0.001); IGF-I/IGFBP-3 molar ratio: pre-pubertal=0.16±0.08 vs pubertal=0.26±0.09 (p<0.001)]. No differences between children on CSII or MI therapy were found. IGF-I SDS was positively related to C peptide level (p<0.001), puberty (p<0.001) and female gender (p=0.02) and negatively related to HbA1c (p=0.04). IGF-I/IGFBP-3 molar ratio was positively affected by C peptide level (p<0.001), puberty (p<0.001) and daily insulin dose (p<0.001).

CONCLUSIONS

Our results indicate that despite intensive insulin therapy, T1DM still negatively affects IGF-I secretion and linear growth. Growth impairment is more severe in males and primarily related to poor glycemic control and loss of the residual beta cell mass.

Growth status of children and adolescents with type 1 diabetes mellitus

BACKGROUND AND OBJECTIVES

Growth parameters are important indicators of a child's overall health, and they are influenced by factors like blood glucose control in diabetic children. Data on growth parameters of Indian diabetic children is scarce. This retrospective, cross-sectional, case control study was conducted at diabetes clinic for children at a tertiary care center at Pune, to study growth parameters of diabetic children in comparison with age-gender matched healthy controls and evaluate effect of different insulin regimes and age at diagnosis of diabetes on growth.

MATERIALS AND METHODS

ONE TWENTY FIVE DIABETIC CHILDREN (BOYS: 50) and age gender matched healthy controls were enrolled. All subjects underwent anthropometric measurements (standing height and weight). Mean height (HAZ), weight (WAZ) and body mass index (BAZ) for age Z scores were calculated. Diabetes control was evaluated by measuring glycosylated hemoglobin (HbA1C). Statistical analysis was done by SPSS version 12.

RESULTS

Mean age of diabetic children and age gender matched controls was 9.7 ± 4.4 years. Diabetic children were shorter (128.3 ± 24.3 cm vs. 133.6 ± 24.7 cm) and lighter (29.2 kg ± 15.3 vs. 31.3 ± 15.4 kg). HAZ (-1.1 ± 1.2 vs. -0.2 ± 0.8) and WAZ (-1.2 ± 1.3 vs. -0.7 ± 1.3) were significantly lower in diabetic children (P < 0.05). Children on both insulin regimes (intensive and conventional) were shorter than controls (HAZ-intensive -1.0 ± 1.0, conventional -1.3 ± 1.3, control -0.2 ± 0.8, P < 0.05). HAZ of children who were diagnosed at <3 years of age was the least (-1.6 ± 1) amongst all diabetic children while those diagnosed after puberty (>14 years) were comparable to healthy controls.

CONCLUSIONS

Growth was compromised in diabetic children in comparison to controls. Children diagnosed at younger age need more attention to optimize growth.

Growth in children and adolescents with type 1 diabetes

OBJECTIVE

To investigate the effect of type 1 diabetes on growth and adult height.

STUDY DESIGN

Data from 22 651 children (10 494 females) with type 1 diabetes documented at onset of the disease from specialized centers in Germany and Austria were analyzed. Patients of non-German and non-Austrian origin and patients with celiac disease were excluded from the analysis. Near-adult height data were available in 1685 patients.

RESULTS

At the time of diagnosis of type 1 diabetes, the mean age of the 22 651 children was 8.8 ± 4.2 years, with a mean height SDS of 0.22 ± 1.0. The 1685 patients with diabetes onset before age 11 years reached a mean adult height of -0.16 ± 1.0 SDS. Mean adult height was was 167.1 ± 6.2 cm (-0.16 ± 0.97 SDS) in females (n = 846) and 179.6 ± 7.1 cm (-0.17 ± 1.0 SDS) in males (n = 839). Mean duration of diabetes was 9.1 ± 2.6 years, and mean Hemoglobin A1c concentration was 7.9% ± 1.2% (63 ± 10 mmol/mol). In a multivariate regression model, adult height was positively correlated with height at onset of diabetes (P < .0001) and negatively with mean Hemoglobin A1c (P < .0001) and duration of diabetes (P = .0015).

CONCLUSION

Height at the time of diagnosis of type 1 diabetes is above average. Even with intensive insulin therapy, growth and adult height remain indicators of metabolic diabetes control in the 21st century.

Development and linear growth in diabetic children receiving insulin pigment

OBJECTIVE

The aim of this study was to ascertain if there are differences in the development and linear growth between a group of diabetic children who had been receiving insulin pigment and healthy children.

METHODS

A total of 57 Chinese children with type 1 diabetes diagnosed at the age from 6 to 10 years old (26 boys and 31 girls) were included in the study. Their height and weight and development conditions were recorded until they reached their 18th birthday.

RESULTS

Diabetic children were taller than healthy children at the onset of diabetes, even though there was no significant difference between them [male height standard deviation score (SDS): 0.34 +/- 0.93, female height SDS: 0.38 +/- 0.50]. When they reached their final height, they were slightly shorter than the healthy group. However, there were still no significant differences between these two groups (male height SDS: -0.42 +/- 0.95, female height SDS: -0.60 +/- 0.98). The median age at onset of puberty, 12.62 years in boys and 11.13 years in girls, was significantly delayed in diabetic boys compared to 10.55 years in healthy boys and 9.2 years in healthy girls. The median age at menarche in diabetic girls (14.15 years) was also delayed compared with 12.27 years in healthy girls. The majority of these diabetic children were thinner than the healthy children when they were diagnosed [male body mass index (BMI): 14.45 +/- 1.35 kg/m2 vs. 16.08 +/- 0.59 kg/m2, t = -0.63, p < 0.05; female BMI: 13.50 +/- 1.87 kg/m2 vs. 15.46 +/- 0.45 kg/m2, t = -6.67, p < 0.05]; however, as they reached their final height, they became fatter, especially the girls (male BMI: 21.43 +/- 1.62 kg/m2 vs. 20.8 +/- 0.00 kg/m2, t = 1.97, p > 0.05; female BMI: 23.95 +/- 2.37 kg/m2 vs. 20.3 +/- 0.00 kg/m2, t = 8.60, p < 0.05).

CONCLUSION

Even with well-controlled glucose levels, the development of children with diabetes who had been receiving insulin pigment were still adversely affected. However, linear growth had only been slightly affected. All patients, especially girls, became fatter when they reached their final height.

[Final size attained in type 1 diabetes children]

OBJECTIVE

To describe the final height and height-gain in relation to target height, in children with type 1 diabetes mellitus, and analyse their relationship to different variables.

PATIENTS AND METHODS

Retrospective analysis of the growth data of 52 children (27 girls) diagnosed with type 1 diabetes mellitus before 14 years old, and followed up until their final height was attained.

MAIN VARIABLES

final height, target height, illness duration, glycated haemoglobin (HbA1c), insulin dose, BMI, and other autoimmune diseases.

RESULTS

The height SDS (standard deviation scale) at diagnosis was slightly higher (0.734 in boys and 0.563 in girls). During the development of the disease, a growth reduction was seen, which was significantly higher in boys of prepubertal age (p = 0.016). The mean final height attained was 173.14 +/- 5.28 cm in boys and 161.9 +/- 6.97 cm in girls. Height gain was 1.56 +/- 3.66 in boys (SDS = -0.034) and 2.26 +/- 6.13 in girls (SDS = 0.385). The only variable significantly related to height gain was mean glycated-haemoglobin (growth reduction of 2 cm for every increment of 1% in mean glycated-haemoglobin).

CONCLUSIONS

At onset, diabetic children were slightly taller than the general population. A growth reduction was shown as the disease developed, significantly higher in boys of prepubertal age. The final height in boys was slightly lower than the mean, but in girls was similar to the general population. Both sexes attained their target height, although the height gain was less in boys. Poorer metabolic control was associated with reduced height gain.

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

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.

Linear growth and height outcomes in children with early onset type 1 diabetes mellitus--a 10-yr longitudinal study

OBJECTIVE

To assess the linear growth and height outcomes and the influence of metabolic control on the near-final height in children with early onset type 1 diabetes mellitus (DM).

STUDY DESIGN AND METHODS

Retrospective longitudinal evaluation of 99 children with prepubertal onset of type 1 DM before 8 yr of age, who were regularly assessed, clinically and metabolically, from 8 yr of age to 17.99 yr of age.

RESULTS

The mean prepubertal height Z scores at 8 yr of age were -0.17 (standard deviation, SD = 0.99) for boys and -0.29 (1.19) for girls, respectively. There was normal linear growth in girls with their mean near-final height Z score being -0.13 (1.07). This was not statistically different from the mean at 8 yr (p = 0.13). The mean near-final height Z score in boys was -0.39 (0.98), which was 0.22 SD lower than their mean prepubertal height Z score (p = 0.03). There was no significant correlation between metabolic control and linear growth in either males or females.

CONCLUSIONS

Linear growth and near-final height in children with type 1 DM compares favorably with the general population. Although there was some evidence of suboptimal peripubertal growth in boys, the actual extent of this height reduction was minimal and was not correlated with their metabolic control.