Delayed pubertal onset and development in German children and adolescents with type 1 diabetes: cross-sectional analysis of recent data from the DPV diabetes documentation and quality management system

Abstract

Objective: To investigate the effect of type 1 diabetes on pubertal onset and development, and to identify factors potentially affecting puberty, including glycemic control, relative diabetes duration, body mass index standard delta score (BMI SDS), insulin dose, and intensity of insulin therapy. Research design and methods: Initiated in 1990, the Diabetes-Patienten-Verlaufsdaten (DPV) is an ongoing, prospective longitudinal follow-up program to benchmark the quality of diabetes care provided to, predominantly, pediatric patients. Data collection for this non-interventional audit was carried out at 202 German diabetes treatment centers. Patient recruitment was done by referral, clinic/hospital ascertainment, or self-report. Data were analyzed for subcohorts of 1218-2409 boys and 579-2640 girls from a cohort of 24 385 pediatric type 1 diabetic patients. Selection was based on ethnicity and availability of data on Tanner stage 2, or higher, of genital and pubic hair development (boys) or breast and pubic hair development, and menarche (girls). Results: Boys showed significant (P!0.05) delay (years) in mean ages at onset of genital development (12.0 (G0.9) years) and pubarche (12.2 (G0.4) years). In girls, mean ages at thelarche (11.4 (G0.5) years), pubarche (11.5 (G0.1) years), and menarche (13.2 (G0.5) years) were significantly delayed compared with the general population. Sexual maturity (Tanner stage 5) was not delayed in either sex. Elevated glycohemoglobin and decreased BMI SDS were associated with significantly delayed pubertal onset, whereas relative diabetes duration and insulin dose were not. Conclusions: Pubertal onset, but not sexual maturity, is delayed in children with type 1 diabetes. Delay increases with higher glycohemoglobin and lower BMI SDS.European Journal of Endocrinology 157 647-653

Puberty and Ovarian Function in Girls with Type 1 Diabetes Mellitus

“…In our study, we observed that T1D girls exhibit a delay in the attainment of breast Tanner stages 3 and 4 [2]. The German study documented a delay of 4 months for Tanner stage 3 only [1, 2], and pubic hair Tanner stages 3 and 4 were delayed in T1D girls from both studies.…”

“…The T1D subjects were treated with 1–7 daily injections and the control group was derived from a large cross-sectional study evaluating pubertal development in 8,689 healthy girls in the mid-1980s. Rohrer et al [1] observed that T1D girls develop thelarche 6 months later than control girls, although the reported age is within the normal range for both groups. The fact that the T1D and control groups were not recruited simultaneously does not limit the conclusions of this study, since the trend for an earlier onset of puberty in healthy girls would increase the difference between both groups.…”

“…Recently, Rohrer et al [1] published a large longitudinal study of 2,578 girls from 200 German centers who were participating in a quality control study for diabetes patients. The T1D subjects were treated with 1–7 daily injections and the control group was derived from a large cross-sectional study evaluating pubertal development in 8,689 healthy girls in the mid-1980s.…”

“…Table 3 summarizes the findings from several studies, which indicate some delay in the age of menarche in girls with T1D, ranging from 2 to 3 months in Wisconsin, USA [31], Rome [32], and Germany [1], 6–9 months in Chile [2], Messina, Italy [33], and Pittsburgh, Pa., USA [7], and 2 years in Sudan [34]. In addition, the presence of a delayed menarche has been associated with subsequent irregular menses and other gynecological disturbances in T1D women [31,35,36,37].…”

“…Severe forms of growth and pubertal delay are now rare, but some degrees of delay in growth and pubertal development may still be observed [1, 2]. During the last decade, the proportion of children with T1D receiving multiple daily insulin injections, which has led to higher insulin daily doses, has increased dramatically [3].…”