Growth disorders in type 1 diabetes: an Indian experience

Abstract

Though children with type 1 diabetes mellitus (T1DM) are often tall at the time of diagnosis, they may experience growth retardation, pubertal delay or both, which may be due to poor glycemic control, associated diseases or chronic complications. Factors affecting growth include: gender, genetic environment, age at diagnosis, diabetes duration, puberty, metabolic control, and status of growth hormone (GH), insulin-like growth factors (IGFs), and IGF binding proteins (IGFBPs). Insulin regulates expression of hepatic GH receptors, affects IGFs and IGFBPs synthesis by modulating GH postreceptor events, and significantly increases IGF-I bioactivity. Low portal insulin seen in T1DM leads to GH hypersecretion, low circulating IGF-I and IGFBP-3, and high circulating IGFBP-1. Newly diagnosed T1DM patients have decreased GHBP which can be restored with insulin therapy. Growth velocity should be appropriate for the age of the child/adolescent, and the mid-parental height. Height, weight and blood pressure (BP) should be measured and plotted on a growth chart at least 2–3 times a year. Puberty should also be assessed annually. Following precautions are to be taken in T1DM children: checking for pubertal onset and ensuring it is not delayed, testing early when growth falters (hypothyroidism/celiac disease/puberty/other conditions), aiming for best possible metabolic control (multidose regimens, regardless of type of insulin), and encouraging dietary calcium and protein, exposure to sunlight, Vitamin D supplements and exercise.

A qualitative study of perceptions of determinants of disease burden among young patients with type 1 diabetes and their parents in South India

“…Virmani mentioned that there is a huge need to better understand the use of non-insulin therapies in Indian communities and traditional medicine approaches and the importance of educating communities about insulin and growth disorders in type 1 diabetes. 7 …”

“… 6 Consequences of this life-changing disease is in India still persisting, such as death before diagnosis due to missed diagnosis, poor management because of low awareness and high costs, limited availability of insulin and poor cold chains in rural areas, and limited availability of blood glucose strips. 7 …”

Long-Term Hyperglycemia Triggered Growth Pattern of Pediatrics with Type 1 Diabetes -A Five-Year Retrospective Follow-Up Study

“…IGFs' most important role is to aid increase in bone length by regulating growth plate chondrocyte proliferation and maturation. Insulin is considered an essential regulator of this process as adequate insulin concentration is needed to maintain normal serum concentrations of IGFs and IGFBPs and intraportal insulin concentrations, which leads to GH hypersecretion, low circulating IGF and IGFBPs [4,5]. Reduced growth of children with T1D may be due to alterations in GH concentrations causing physiological abnormalities in bone growth [6,7].…”

“…Adequate insulin concentration is needed to maintain normal serum concentrations of IGFs, and IGFBPs. IGFs had a pivotal role in both muscle and bone turnover with subsequent increase in bone length by regulating growth plate chondrocyte proliferation and maturation[4,5,15]. Earlier studies reported that IGF-1 serve as a significant determinant of height; this has a more substantial influence than glycemic control and insulin level[16].…”

Growth of children with type 1 diabetes mellitus

“…Kluczowe jest dążenie do poprawy wyrównania metabolicznego [28]. Istotne są: młodszy wiek zachorowania, czas trwania choroby, przebieg okresu pokwitania, płeć, metoda insulinoterapii, choroby dodatkowe [23,32].…”