ESPE Abstracts

Introduction: Currently, the incidence of diabetes in children is increasing and may coexist with growth hormone deficiency. In diabetic patients, there are many mechanisms which disrupt the growth process and affect the GH/IGF-1 axis. However, with properly controlled diabetes, patients achieve normal height and should be diagnosed for causes of short stature other than diabetes. There are few reports on the safety and effects of the use of recombinant human growth hormone (rHGH) in patients with growth hormone deficiency (GHD) and type 1 diabetes. The purpose of the presentation is to demonstrate the effects of rHGH treatment in a patient with GHD and type 1 diabetes.

Case study: The girl was diagnosed with diabetes at the age of 15 months and treated with personal insulin pump with good compensation. From the age of 2, the child’s growth curve was below the 3rd percentile. At the age of 7 the girl was diagnosed with GHD. Family history revealed that the child’s father had been treated with rHGH for GHD. At the age of 7 and 2 months, the girl started rHGH therapy.

Results: After the introduction of treatment, cath-up growth was observed. At the start of rHGH administration, the girl’s height was 113.2 cm (<3rd percentile, -2.13 SDS); after one year of treatment it was 121.1 cm (3-10 percentile, -1.71 SDS). Currently, the height of the 13-year-old and 6-month-old child is 155 cm (10-25 percentile; -1.35 SDS). IGF-1 levels were constantly monitored and kept close to the lower normal range. After rHGH began to be used, the need for insulin increased. Before rHGH therapy, it was approx. 0.6 U/kg of body weight/day, after the start of rHGH therapy, it increased to approx. 1 U/kg of body weight/day; currently it is 0.9 U/kg of body weight/day. No deterioration of the metabolic control of diabetes has been observed. There were no signs of diabetic retinopathy.

Conclusions: In diabetic patients, it is advisable to also look for reasons of short stature other than metabolic imbalance, because children with well-controlled diabetes are not affected by growth disorders. Based on the literature and our own observations, it seems that treating diabetic children with rHGH is safe and beneficial. There is a need to conduct research on larger groups to assess the safety and effects of rHGH therapy in children with type 1 diabetes.