Pubertal Growth in ID DM Is Determined by HbA1c Levels, Sex, and Bone Age

Ahmed, Marion L.; Connors, Matthew H.; Drayer, N.M.; Jones, Jessica; Dunger, David B.

doi:10.2337/diacare.21.5.831

Cited by 75 publications

(85 citation statements)

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“…Although unproven, this sex-related difference in association between adiponectin and adiposity may relate to the timing of accumulation of intra-abdominal fat and greater insulin resistance in females than in males [25] and to the effects of sex steroids [18]. In type 1 diabetes, timing of puberty is altered [26] and BMI and insulin resistance are increased during adolescence, particularly in girls [27,28]. Furthermore, risk of microalbuminuria in female adolescents is associated with higher androgen levels [29].…”

Section: Discussionmentioning

confidence: 99%

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

et al. 2008

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Aims/hypothesis We determined the longitudinal relationship between adiponectin levels and the development of microalbuminuria in an inception cohort of children with type 1 diabetes. Methods Blood samples collected annually over a median of 9.0 (range 1.3-14.9) years were assayed for adiponectin and HbA 1c in 55 children (36 girls) with type 1 diabetes and microalbuminuria whose age of onset of diabetes was 9.4 years (range 2.2-15.4). Samples were also assayed from normoalbuminuric children (controls) matched for age, sex and duration of diabetes. Results Overall, adiponectin levels were higher in girls than in boys, but only after 11 years of age (median [range]: 15.3 [5.8-124.4] vs 11.6 [4.1-26.5] mg/l, p<0.001). Furthermore, adiponectin levels were higher in girls with microalbuminuria than in control girls, but this was only apparent after the onset of microalbuminuria (p=0.001, adjusted for BMI, daily insulin dose, HbA 1c and age). In boys, adiponectin levels did not differ between those with microalbuminuria and controls. Further sex-related discordant associations with adiponectin levels were observed; in girls, adiponectin levels were positively related to HbA 1c levels (r=0.2, p=0.05) and urine albumin excretion (r=0.3, p<0.05) and inversely related to BMI (r=−0.2, p<0.05). These associations were absent in boys. Conclusions/interpretation In adolescent girls with type 1 diabetes but not in boys, adiponectin levels increase with increasing urine albumin excretion and onset of microalbuminuria. Although causal links cannot be inferred, this sexual dimorphism may reflect interactive effects of hyperglycaemia and sex steroids on risk of complications and adiponectin production.

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Section: Discussionmentioning

confidence: 99%

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

et al. 2008

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“…Healthy females are less insulin-sensitive than healthy males. Such decreased sensitivity is compensated by increased insulin secretion (32). Some studies have also shown that both HbA1c and insulin dose were significantly higher in female patients (14,16,33).…”

Section: Comparison With Other Studiesmentioning

confidence: 98%

Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood

Samuelsson

Anderzén

Guðbjörnsdóttir

et al. 2016

Journal of Diabetes and its Complications

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“…In agreement with different studies (22) and different cultural backgrounds, pubertal girls presented higher mean A1C values than boys. It has been shown that linear growth might also be impaired in children even when reasonable glycemic control had been achieved (23,24), and this growth pattern is likely to be more pronounced in a setting in which metabolic control is very poor. In fact, most of our children had short stature, which was more pronounced in puberty, in accordance with other studies (25,26).…”

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confidence: 99%

Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania

et al. 2007

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OBJECTIVE -The purpose of this study was to assess glycemic control and complications of type 1 diabetes in children and adolescents in Tanzania. RESEARCH DESIGN AND METHODS -This demographic and clinical survey in-cluded 99 children aged between 5 and 18 years attending Muhimbili National Hospital Clinic for Diabetes. A structured questionnaire was used for evaluating socioeconomic data and for estimation of the prevalence of acute complications occurring over the last 6 months. The prevalences of retinopathy and diabetic nephropathy were determined by fundus ophthalmoscopy and by microalbuminuria, respectively.RESULTS -All of these children were treated with a conventional insulin regimen. The mean Ϯ SD duration of diabetes was 4.76 Ϯ 3.58 years. Only 1 child (1%) had good glycemic control (A1C Ͻ7.5%), 60 children (60.6%) had moderate glycemic control (A1C 7.5-10%), 14 children (14.1%) had poor glycemic control (A1C Ͼ10 -12.5%), and 24 children (24.2%) had very poor glycemic control (A1C Ͼ12.5%). At onset of diabetes, 75% of children presented with diabetic ketoacidosis (DKA); 89 children (89.80%) had at least one episode of DKA, and 55 children (55.67%) had symptomatic hypoglycemic episodes. Microalbuminuria was present in 29 (29.3%) and retinopathy in 22 (22.68%) children.CONCLUSIONS -Although there are some methodological limitations, this survey highlights the difficulties of achieving good metabolic control and the high prevalence of acute and chronic complications in Tanzanian children with type 1 diabetes. These results clearly show that major efforts are needed to improve quality of care in children with type 1 diabetes in Tanzania. Diabetes Care 30:2187-2192, 2007T ype 1 diabetes is one of the most frequent chronic disease in children and represents a public health challenge globally. Its burden is huge in developing countries owing to the lack of a basic means for reaching reasonable glycemic control. Because of the unavailability of reliable epidemiological data, the natural history of type 1 diabetes, including its complications, is largely unknown (1). With the few data available on subSaharan African children, incidence in Tanzania was estimated to be 1.5/ 100,000 (2), and an increase in incidence in Sudan from 9.5/100,000 in 1991 to 10.3/100,000 in 1995 has been reported (3). The prevalence is higher in Western countries (4,5), suggesting the possibility of missed diagnosis in sub-Saharan Africa. In fact, the problem of missed diagnosis of childhood diabetes, although not unique to developing countries (6), is certainly much more common than in developed countries (7). In a Sudanese study, it was reported that 10% of children were not admitted at the time of diagnosis, being admitted only after they developed diabetic ketoacidosis (DKA) or hypoglycemia (3). This situation contributes to omission of patients in the registry as well as to the possibility of death before diagnosis, especially for those aged Ͻ5 years. In sub-Saharan Africa, most children present with DKA at the time of diagnosis (8,...

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Pubertal Growth in ID DM Is Determined by HbA1c Levels, Sex, and Bone Age

Abstract: We conclude that the magnitude of the pubertal growth spurt is related to HbA1c levels in both sexes, but it is reduced only in girls. This sexual dimorphism cannot be explained by differences in IGF-I levels and may relate to the bone age advance at the onset of puberty in the girls.

Cited by 75 publications

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The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood

Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania

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