Croissance des enfants atteints de diabète insulinodépendant. Étude de 104 observations

Abstract

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 A 1c was measured using high performance liquid chromatography (normal range: 5.0 ± 1.0%; m ± 2 DS). Results. — At diagnosis, height (evluated in SD) did not differ between diabetic children and controls. Three years before the onset of diabetes, boys were taller compared in controls (1.02 ± 0.20 vs 0.41 ± 0.17; P < 0.05; m ± SEM). Children five years 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 A 1c levels (r = −0.57). Growth changes front the onste of diabetes to the end of growth were correlated with age at diagnosis, (boys: r = 0.73; girls: 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.