Linear Growth in Children and Adolescents with Type 1 Diabetes Mellitus.

Elisa Santi,Giada Toni,Maria Giulia Berioli,Giorgia Tascini,Susanna Esposito

doi:10.3390/ijerph16193677

Abstract

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.

Highlights

Type 1 diabetes mellitus (T1DM) is the most common chronic metabolic disorder in children.the incidence of childhood onset T1D varies significantly between and within countries, ranging from 0.1 cases in Venezuela to more than 40 cases in Finland per 100,000/year [1] In recent years, it has been calculated that T1DM is increasing at a rate of ~3–5% per year
The EURODIAB Study Group conducted a retrospective study showing that height standard deviation (SDS), weight SDS, and body mass index (BMI) SDS were significantly increased in T1DM patients compared to healthy children, with the maximum differences occurring between one and two years of age, demonstrating that increased early growth could be associated with disease risk in European populations [66]
IGF-I SDS and IGF-I/insulin-like growth factor binding proteins (IGFBPs)-3 molar ratio were significantly lower in M than in F

Summary

Introduction

Type 1 diabetes mellitus (T1DM) is the most common chronic metabolic disorder in children. The EURODIAB Study Group conducted a retrospective study showing that height standard deviation (SDS), weight SDS, and body mass index (BMI) SDS were significantly increased in T1DM patients compared to healthy children, with the maximum differences occurring between one and two years of age, demonstrating that increased early growth could be associated with disease risk in European populations [66]. The authors showed that metabolic control (expressed as HbA1c levels) influenced the growth pattern and demonstrated that height velocity after T1DM diagnosis was directly correlated with pancreatic beta cell residual activity, evaluated as C-peptide levels [54]. The growth rate seems to be influenced by age at T1DM onset, with a the most severe growth impairment occurring in children with disease diagnosis in early childhood [31,57,65,74]

Growth during Puberty and Final Adult Height in Patients with Type 1 Diabetes

Conclusions

H SDS at study end

H SDS at study end: M

Findings