Background: Impaired linear growth and low IGF1 levels, strictly related to poor glycemic control have been reported in children with type 1 diabetes (T1DM).
Objective and hypotheses: We studied growth and growth factors in 91 T1DM young patients, 54 males (age: 11.73±3 years, disease duration: 5.2±2.9 years). All subjects were on intensive insulin therapy: 72 children by multiple injection therapy (MI), 19 children by continuous subcutaneous insulin infusion (CSII). Twenty-seven subjects were pre-pubertal, 64 were pubertal.
Method: Anthropometric and biochemical parameters (HbA1c, C-peptide, IGF1, and IGFBP3) were recorded at 6-month intervals. Duration of follow-up was 2.9±0.28 years.
Results: Height velocity (HV) SDS was found higher in females than in males (females: 0.6±2.4 vs males: −0.45± 2.3). Growth factors levels were higher in females than in males (IGF1 SDS: females −1.0± 0.5 vs males −1.4±0.6, P: 0.02; IGF1/IGFBP3 molar ratio: females 0.26±0.1 vs males 0.21±0.08, P: 0.04) and in pubertal children compared to pre-pubertal children (IGF1 SDS: pre-pubertal −1.58±0.4 vs pubertal −1.1±0.6, P: 0.03; IGF1/IGFBP3 molar ratio: pre-pubertal 0.16±0.08 vs pubertal 0.26±0.09, P< 0.001). No differences in terms of HV SDS, IGF1 SDS, and IGF1/IGFBP3 molar ratio were evident between children treated with different therapeutic modalities (CSII vs MI therapy). Multivariate analysis showed that HV SDS was positively affected by IGF1 SDS (P: 0.04) and negatively related to T1DM duration (P: 0.01). IGF1 SDS was positively affected by female gender (P: 0.02), puberty (0.01) and C-peptide levels (P<0.001), and inversely related to HbA1c levels (P: 0.04).
Conclusion: A negative impact of T1DM on growth and growth factors remains evident despite intensive insulin therapy, probably due to a defect of portal insulinization. The effect seems to be independent from treatment modalities and primarily related to glycemic control and residual β cell mass.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology