ESPE Abstracts

Background: Type 1 diabetes (T1D) being a chronic disease is likely to affect growth in children. Bone age helps in assessing the growth of child in relation to their skeletal maturity. Skeletal maturity is delayed in chronic systemic illness.

Objective: To study growth in relation to bone age and chronological age in children with T1D.

Methods: Study design: Prospective observational study at a tertiary care pediatric endocrine unit where children with T1D with disease duration of more than 1 year were included in the study. We present here a 3 year follow up. Apart from regular care, detailed follow-up of diabetes on yearly basis is carried out including clinical history, anthropometry, bone age (by TW3 method) and HbA1c. Chronological age (CA), bone age (BA) and disease duration were noted. National references were used to calculate Height Z score for chronological age (HAZ) and height Z score for bone age (HBZ). All data were recorded and analysis was performed with SPSS 25.0.

Results: A total of 78 (42 boys and 36 girls) children were included in the study. The mean age at baseline was 10.3±3.6 yrs with mean disease duration at baseline of 3.6±3.1 yrs. HAZ at baseline, 1 yr, 2y and 3 yr of follow-up were -0.78±1.1, -0.82±1.1, -0.72±1 and -0.87±0.9 for boys and -0.7±1.2, -0.64±1.1, -0.65±1.1 and -0.2±1.3 for girls respectively. HBZ was -0.68±1, -0.47±1, -0.48±1.2 and -0.51±1.1 among boys and -1±0.9, -0.7±0.7, -0.7±-09 and -0.28±1.6 among girls at baseline, 1 yr, 2yr and 3 yr respectively. CA and BA had a significant co-relation (r=0.82, P<0.05). From baseline to the 3 year follow-up, there was a significant decline in HAZ in boys while girls showed an improvement (P<0.01). HBZ improved in boys significantly but not in girls (P<0.05 and P=0.95). Ratio of CA and BA showed a decline from 1.02±0.15 to 1.05±0.13 (P<0.05) in boys and in girls 0.98±0.14 to 1.01±0.14 (P=0.45). HbA1c had a negative co-relation with HAZ and HBZ but was not statistically significant.

Conclusion: Children with diabetes were short in comparison with reference growth data. In boys the advancement in bone age was significantly slower compared as to the chronological age. It is critical to monitor growth in relation to skeletal maturity in children with diabetes.