Growth Trajectory in Children with Type 1 Diabetes Mellitus: The Impact of Insulin Treatment and Metabolic Control

Abstract

Background: Linear growth was reported to be negatively affected by type 1 diabetes mellitus (T1DM), in relation to disease duration and poor metabolic control. It is unclear whether a subtle growth failure still persists despite the optimization of therapy. Our aim was to analyse pubertal growth, adult height, and metabolic profile in a cohort of children with T1DM undergoing intensive insulin treatment by multiple daily injections or continuous subcutaneous insulin infusion (CSII). Methods: One-hundred and four children (51 males) with prepubertal onset of T1DM were prospectively followed up to final height attainment. Results: Age at puberty onset was 11.7 ± 1

Earlier puberty in boys with type 1 diabetes mellitus compared to a simultaneously recruited group of control adolescents

“…Abnormalities in growth and puberty in children with type 1 diabetes mellitus (T1D) have been prevalent complications in children with poor metabolic control; concerns about deficiencies in final height or the timing of pubertal development remain …”

Linear Growth in Children and Adolescents with Type 1 Diabetes Mellitus

“…Though modern therapies based on MDI or CSII with new insulin analogues ensure more physiological insulin supplementation than previous therapies, some anomalies of the GH/IGF-1 axis are still detectable due to persistent hepatic hypo-insulinization. However, modern intensive insulin regimens, leading to improved metabolic control, are able to ensure a normal adult height in line with patients’ target parameters [22,59]. Therefore, 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.…”

“…Height at the diagnosis of T1DM in children is a debated topic in the literature. Many studies have reported that children at the onset of T1DM were taller than their healthy peers [27,46,47,48,49,50,51,52,53,54,55,56,57,58,59], while other authors have not confirmed these data [29,30,60,61,62] (Table 1). A possible reason for the differences between these results could be the secular trend in growth (i.e., the fact that puberty is starting earlier for boys and girls now than it did a hundred years ago) and an inadequate choice of controls [63].…”

“…Despite the growth anomalies described, most studies have shown that children with T1DM reach a normal or only slightly reduced final height compared to the reference population [30,32,46,51,56,59,74,83,91] (Table 1). In agreement with these findings, Brown et al, in their study on 184 children with T1DM, reported that, despite a reduced growth spurt during puberty, the children attained a final height corresponding to the mid-parental height.…”

“…It was recently demonstrated that adult height SDS could be positively influenced by good basal insulinization during puberty [59]. On the other hand, the use of CSII therapy does not seem to improve chronic hepatic hypo-insulinization and does not seem to influence the linear growth pattern compared to MDI therapy [31].…”