Clinical Care/Education/Nutrition N A L A R T I C L E Pubertal Growth, Sexual Maturation, and Final Height in Children With IPDM Effects of age at onset and metabolic control MARIACAROLINA SALERNO, MD, PHD ALESSANDRO ARGENZIANO, MD SALVATORE DI MAIO, MD NLCOLETTA GASPARINI, MD, PHD STEFANIA FORMICOLA, MD GlANPAOLO DE FlLIPPO, MD ALFRED TENORE, MD OBJECTIVE — To evaluate growth and pubertal development in children with IDDM and the influence of the age at onset of IDDM and the degree of metabolic control on final height. RESEARCH DESIGN AND METHODS — We conducted a retrospective evaluation of 62 subjects followed longitudinally both clinically and metabolically from the onset of IDDM until final height was reached. RESULTS — Height at diagnosis was within the normal percentiles in boys (0.5 ±1.0 stan- dard deviation score [SDS]) and girls (0.4 ±1.0 SDS), but above the genetic target height (—1.0 ± 0.9 SDS in boys and —1.1 ± 0.6 SDS in girls; P = 0.0001 for both comparisons). Although a lesser height gain was observed during the ensuing years, the final height reached by boys (—0.4 ± 1.1 SDS) and girls (—0.4 ± 0.9 SDS) was higher than the genetic target height. Blunted total pubertal growth was observed both in boys (24.5 ± 3.6 cm) and girls (20.1 ± 4.2 cm). The decrease in height gain was independent of the duration of IDDM, the degree of metabolic con- trol, or the insulin requirement. The greater the height at diagnosis, with respect to the genetic target height, the lesser was the subsequent height gain to reach final adult height (r = 0.34, P < 0.01). BMI increased with age as normally occurs in healthy children, independent of the duration of disease and the degree of metabolic control. Pubertal development began and pro- gressed normally both in boys and girls. In boys, a testicular volume of 4 ml was reached at a mean age of 12.1 ± 0.9 years. In girls, breast enlargement occurred at a mean age of 10.4 ± 1.2 years and the mean age of menarche was 12.8 ± 1.4 years. Pubertal development and progres- sion occurred independent of the age at onset of IDDM, the glycemic control, or the insulin requirement during the pubertal period. CONCLUSIONS — Children with IDDM have normal onset of puberty and normal sexual maturation. Even though final height falls within the normal percentiles, the diminished height gain after diagnosis requires further investigation. I mpaired longitudinal growth and puber- tal delay were common complications in children with uncontrolled diabetes (1). With the improvement in therapeutic regi- men, regular diet, and physical activity, nor- mal growth should be expected in children with IDDM. However, data on growth and pubertal development still remain contro- versial (2-5), and above all it is unclear whether the degree of metabolic control or the duration of the disease affect sexual development and final height (3,6-8). Although the literature is replete with descriptions of height at diagnosis, there are still few data regarding longitudinal growth to final height of children with diabetes. The aim of this study, therefore, was J) to review pubertal growth and sexual mat- From the Department of Pediatrics (M.S., S.D.M., N.G., S.E, G.D.E), University "Federico II," Naples, and the Department of Pediatrics (A.T.), University of Udine, Udine, Italy. Address correspondence and reprint requests to Mariacarolina Salerno, MD, Department of Pediatrics, University "Federico II," via Pansini 5, 80131 Napoli, Italy. Received for publication 13 June 1997 and accepted in revised form 9 December 1997. FH, final height; GTH, genetic target height; HDX, height at diagnosis; HPO, height at onset of puberty; SDS, standard deviation score. uration in 62 patients with IDDM followed longitudinally to final height and 2) to eval- uate the influence of the age at clinical onset of IDDM and the degree of metabolic control both on pubertal development and final height. RESEARCH DESIGN AND M E T H O D S — The study population consists of 62 children (32 boys and 30 girls) followed longitudinally in our depart- ment from the onset of IDDM (range, 0.8-12.7 years) to the attainment of adult height. Subjects with additional problems that could affect growth (i.e., thyroid or celiac disease, etc.) were excluded. The par- ents of the children gave informed consent for participation in the study. All patients were treated with 2 or 3 doses per day of a mixture of regular and intermediate insulin. The dose and compo- sition of the insulin injections were adjusted according to home glucose monitoring. Patients were seen every 3 months for clin- ical evaluation, assessment of metabolic control by the determination of HbA lc lev- els, and to discuss further treatment. Meta- bolic control during puberty was expressed as the mean of HbA lc values obtained every 3 months during the pubertal period. The HbA lc assay was performed using Diamant high-performance liquid chromatography system; the range for nondiabetic children was 3.7-6.7%. HbA lc values of the children during puberty ranged from 6.0 to 14.5%. A mean pubertal value of HbA le <8.0% was considered good metabolic control. Height, measured by Harpenden stadiome- ter, was expressed as a standard deviation score (SDS) for chronological age according to Tanner (9). British growth standards were chosen since they are very similar to our regional percentiles (10). Final height, eval- uated at a mean age of 18.7 ± 0.8 years in male subjects and 17.6 ±1.1 years in female subjects, was defined as a growth velocity of less than 1 cm in the preceding year. Parental height was measured at the first observation and the genetic target height (GTH) calculated according to Tanner (11). BMI was calculated and evaluated according to Hammer et al. (12). DIABETES CARE, VOLUME 20, NUMBER 5, MAY 1997 721 Downloaded from http://diabetesjournals.org/care/article-pdf/20/5/721/584119/20-5-721.pdf by guest on 20 December 2023