Background: Adolescents with Type 1 Diabetes (T1D) have worse metabolic control than preadolescent children due to poor adherence with medications and insulin resistance related to puberty hormones. Adolescent girls are at a particular risk for poor control as insulin sensitivity decreases in the luteal phase and menstrual cycle. Progesterone, secreted in the second half of the cycle, may cause an increase in appetite and caloric intake.
Objectives: This study was conducted to assess the effect of puberty on the glycemic control of adolescent type 1 diabetic females following up in Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU) of the Children's Hospital of Cairo University and to study the effect of menstruation on insulin demand and blood glucose control in these girls.
Patients and Methods: A cross-sectional study on thirty pubertal adolescent girls (group 3), thirty prepubertal girls (group 1) and thirty boys in variable stages of puberty (Group 2-Tanner stages 2-5) all with ages ranging from 10-15 years and similar mean T1D duration (5.12-5.42 years). We compared mean blood glucose levels, mean insulin doses and mean HbA1Cs (average of the last 4). In Addition, group 3 patients were asked to keep tight records of their blood glucose one week before and during the week of menstruation and to increase their insulin doses to correct for any high blood sugars as needed. We also compared the degree in the participation in sports, psychological issues in the three groups.
Results: Mean blood glucose levels were higher in pubertal girls than in both other groups reflected also in their mean HbA1Cs and insulin requirements (P<0.05). A third of pubertal girls did not participate in any form of walking or sports compared to 13.3% of pubertal boys and 20% of pubertal girls. The difference was highly significant (P<0.001). Anorexia and dissatisfaction of body image was non significantly more in pubertal girls. Fears from not finding a spouse were significantly higher in pubertal girls (P= 0.4). About half of the adolescent girls haven't told their friends about their diabetes (P<0.001)
Conclusion: Puberty and menstruation in T1D girls have an adverse effect on diabetes control. Closer monitoring is needed during the menstrual cycle. Higher HbA1C levels may also be related to lower participation in sports in this group which is common in Arab countries. Sports should be encouraged in this group. Psychological care should be specially addressed to this vulnerable group.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology