Prognostic signs of the course of puberty in adolescents with type 1 diabetes

Abstract

Objective — to determine significant clinical, anamnestic and hormonal factors on the prognosis of puberty disorders in modern adolescents with type 1 diabetes.
 Materials and methods. A comprehensive examination involved 233 patients with type 1 diabetes aged 9 to 18 years, who were examined and treated in the Endocrinological Department of the SI «ICAHC NAMS». Based on the results of assessment of the physical and sexual development, the groups of patients with a physiological and pathological course of puberty have been distinguished. To determine significant prognostic clinical, anamnestic, hormonal and metabolic signs regarding the course of puberty in adolescents with type 1 diabetes, the system and information analysis, heterogeneous sequential statistical technique «the Wald test» with the application of the Kullback—Leibler information measure was used. Creating a database and statistical processing of the results were carried out using application packages Microsoft Excel and SPSS 17.0 programs.
 Results and discussion. The most informative factors have been determined for prognosis of the course of physical and sexual development in adolescents with type 1 diabetes, and the informativeness and predictive coefficients (PC) of initial clinical, anamnestic and hormonal data indicators have been calculated. The most informative signs were combined with the table of physical and sexual development of girls and boys with type 1 diabetes. Despite some gender features of predicting the course of physical and sexual development in boys and girls, it has been proven that the most significant factors in predicting the course of puberty in patients with type 1 diabetes are the period of puberty in which the manifestation of diabetes occurred, the state of compensation carbohydrate metabolism, the level of self-control and the presence of comorbid thyroid gland pathology. Common adverse factors included manifestation of type 1 diabetes in childhood and in the early stages of puberty; the use of short-acting and long-acting human insulins; insufficient or excessive dose of exogenous insulin during puberty; unsatisfactory level of compensation of carbohydrate metabolism with high variability glycaemia during the day and low indicators of the duration of stay in the target range state; low level of diabetes self-control and lack of devices for monitoring of blood glucose; presence of thyropathy with signs thyroid insufficiency.
 Conclusions. The possibility to predict the course of puberty in an individual patient is the basis for the development of an individual preventive and therapeutic program, aimed at preserving the reproductive potential and social adaptation of adolescents with type 1 diabetes.