Growth and Development Differences During Puberty in Children With T1D

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The worst growth velocity was seen in children with a mean HbA1c >9%.
The worst growth velocity was seen in children with a mean HbA1c >9%.

Children with type 1 diabetes (T1D) may have an altered growth pattern compared with children without T1D, with boys diagnosed with T1D experiencing metabolic impairment during peak growth velocity, according to a study published in the Journal of Diabetes Research.

Researchers identified 1294 children with T1D during pubertal growth via a diabetes registry in Germany to assess whether there is a relationship between hemoglobin A1c (HbA1c) deterioration and pubertal growth spurt.

The investigators hypothesized that insufficient metabolic control may be associated with impaired pubertal control, as impairment in overall adult height in children diagnosed with T1D has been observed.

The study results showed an increase in HbA1c in boys between age 12 and 14  (increment to preceding measurement +0.4; P =.027), covering the period of normal maximum growth (age 13 to 14).  However, a relationship between an increase in HbA1c and maximum growth spurt was not identified in girls as maximum growth occurred between age 11 and 12, while higher HbA1c levels were noted at both age 10 to 11 and 15 to 16 (P =.012 and P =.018, respectively). 

There were no differences in time of pubertal growth spurts between children with or without T1D.  In girls, no differences in maximum growth velocity were identified overall (P =.05), but study results did show a more rapid decline in growth velocity in girls with T1D compared with the control population.

Groups were created based upon good metabolic control defined as long-term mean HbA1c <7.5% (n=647; female, 308), and groups with poor metabolic control with a mean HbA1c ≥7.5% during all documented years (n=647; female, 323).  While growth spurts were impaired overall in children diagnosed with diabetes, growth velocity was more impaired in children with poor metabolic control, with the most significant impairment noted in children with an HbA1c >9%.

During this study, the height standard deviation score in both boys and girls with T1D compared with children without T1D differed significantly (P <.0001); this difference was no longer evident once the children reached age 16. Body mass index (BMI) was also found to differ between children with and without T1D both during the study and after the children reached age 16 (P <.0001 and P <.0001, respectively).

Researchers concluded that while the timing of pubertal growth spurts in boys and girls both with and without T1D did not differ significantly and ultimately all participants reached normal height by age 16, in boys with T1D a 1.2 cm/year reduction was found during the time of maximal growth velocity compared with boys without T1D.  A difference in the median maximum growth velocity in girls was not found compared with girls without T1D, but there was a faster growth velocity decline.  Therefore, the differences in height in boys can potentially be attributed to the loss of maximum growth velocity, and in girls to the more rapid decline in growth velocity.

Reference

Plamper M, Gohlke B, Woelfle J, et al. Interaction of pubertal development and metabolic control in adolescents with type 1 diabetes mellitus. J Diabetes Res. 2017;2017:8615769.

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