[Growth of children with insulin-dependent diabetes. Study of 104 cases].

BACKGROUND: Results of studies of growth in children with diabetes mellitus are still conflicting. In a cross-sectional and longitudinal study, statural growth was analysed in a sample of diabetic children in order to specify its characteristics and relationship with various factors. POPULATION AND METHODS: One hundred and four children (53 girls and 51 boys) with insulin-dependent diabetes for more than 3 years have been studied (age at onset and duration of diabetes, respectively, 6.4 +/- 4.1 and 8.5 +/- 4.8 in girls; 6.1 +/- 3.9 and 7.9 +/- 3.9 in boys; m +/- SD). A control group included 51 boys (age: 8.9 +/- 2.9) and 49 girls (age: 9.3 +/- 2.7). Data were collected every three months. Hemoglobin A1c was measured using high performance liquid chromatography (normal range: 5.0 +/- 1.0%; m +/- 2 DS).
RESULTS: At diagnosis, height (evaluated in SD) did not differ between diabetic children and controls. Three years before the onset of diabetes, boys were taller compared to controls (1.02 +/- 0.20 vs 0.41 +/- 0.17; P < 0.05; m +/- SEM). Children five years after the onset of disease were overweight compared to controls (girls: 0.96 +/- 0.16 vs 0.00 +/- 0.20; boys: 0.59 +/- 0.16 vs -0.04 +/- 0.15; P < 0.01; m +/- SEM). Longitudinal study showed a progressive decrease of mean growth velocity starting at least 2 years before the onset of diabetes and proceeding until the end of growth. From diagnosis to the end of height development, there was a growth loss of 0.66 SD in girls (p < 0.01) and 0.69 SD in boys (p < 0.05). This alteration of growth affected more clearly children who became diabetic before the onset of puberty, especially those with early-onset diabetes and bad metabolic control. Growth changes for the first 5 years of diabetes were significantly and negatively correlated with mean hemoglobin A1c levels (r = -0.57). Growth changes from the onset of diabetes to the end of growth were correlated with age at diagnosis, (boys: r = 0.73; girls: r = 0.37). During puberty, girls exhibited a reduced growth spurt, especially when they were overweight and received too low doses of insulin.
CONCLUSIONS: On the whole, diabetic children were growing in normal range. Growth was adversely and mainly affected by early-onset diabetes, a long duration of disease, many years of poor metabolic control and, especially in adolescent girls, low doses of insulin and weight excess.