Development according to pubertal stage in Brazilian children and adolescents with short-term diabetes

Transcription

1 Brazilian Journal of Medical and Biological Research (2001) 34: Development according to pubertal stage in children with diabetes ISSN X 1315 Development according to pubertal stage in Brazilian children and adolescents with short-term diabetes V.T. Fernandes, I.T.N. Verreschi and S.A. Dib Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil Correspondence S.A. Dib Disciplina de Endocrinologia EPM, UNIFESP Rua Botucatu, 740 Caixa Postal São Paulo, SP Brasil Publication supported by FAPESP. Received September 22, 2000 Accepted August 9, 2001 Abstract Key words Brazilian type 1 diabetes Growth and development Pubertal stage Introduction

2 1316 V.T. Fernandes et al. Subjects and Methods Subjects Auxology and puberty

3 Development according to pubertal stage in children with diabetes 1317 Assessment of glycemic control Treatment Statistical analysis Table 1. Equations of height and weight adjustments to chronological age (years) at each sexual maturation stage of girls and boys of the present study. Girls (N = 60) Boys (N = 132) Height Weight Height Weight B1: Y H = X Y W = X G1: Y H = X Yw = X B2: Y H = X Y W = X G2: Y H = X Y W = X B3: Y H = X Y W = X G3: Y H = X Y W = X B4 + B5: Y H = X Y W = X G4: Y H = X Y W = X G5: Y H = X Y W = X B1-B5 = breast; G1-G5 = genital development according to the Tanner scale. Y H or Y W = height or weight adjusted for age and pubertal age. X = chronological age in years.

4 1318 V.T. Fernandes et al. Results Table 2. Clinical characteristics of children with type 1 diabetes mellitus at diagnosis and at the end of follow-up. Girls (N = 24) Boys (N = 27) Initial Final Initial Final Age (median [range], years) 11 [ ] 14.4 [ ] 10.6 [ ] 13.8 [ ] Prepuberal, N (%) 10 (41.7) 4 (16.7) 19 (70.3) 7 (25) Time from diagnosis # 27 ± 47 days 3.5 ± 1.4 years 67 ± 71 days 4.0 ± 1.1 years Height (cm) # ± ± ± ± 16.0 Z-score * Y-control for height Above, N (%) 10 (42.0) 7 (29.2) 7 (25.9) 8 (29.6) Equal, N (%) 6 (25.0) 3 (12.5) 4 (14.8) 5 (18.5) Below, N (%) 8 (33.3) 14 (58.3) 16 (59.3) 14 (51.8) Weight (kg) # 32 ± ± ± ± 14.1 Z-score Y-control for weight Above, N (%) 9 (37.5) 14 (58.2) 8 (29.6) 7 (25.9) Equal, N (%) 2 (8.3) 3 (12.3) 1 (3.7) 0 Below, N (%) 13 (54.2) 7 (29.2) 18 (66.7) 20 (74.1) BMI (kg/m 2 ) # 17 ± 3 20 ± 3 16 ± 2 18 ± 2 # Data are reported as means ± SD. N (%) = number (percentage). *P<0.05 compared to the initial value (Mann-Whitney test).

5 Development according to pubertal stage in children with diabetes 1319 A Height (cm) B Height (cm) Figure 1. Height in relation to age and pubertal stage (Tanner s classification; B1 to B4 + B5) at diagnosis (A) and at final evaluation (B) in type 1 diabetic girls. B1-B5: breast development. A Height (cm) B Height (cm) B1 B2 B3 B4 + B Chronological age (years) G1 G2 G3 G4 + G Chronological age (years) Figure 2. Height in relation to age and pubertal stage (Tanner s classification; G1 to G4 + G5) at diagnosis (A) and at final evaluation (B) in type 1 diabetic boys. G1-G5: genital development.

6 1320 V.T. Fernandes et al. A Z-score Discussion Weight Height Weight Height 0 P<0.05 Initial B Z-score Final Figure 3. Weight and height Z-score at diagnosis and at final evaluation in type 1 diabetic girls (A) and boys (B).

7 Development according to pubertal stage in children with diabetes 1321

8 1322 V.T. Fernandes et al. Acknowledgments References 1. Hoskins PJ, Leslie RDG & Pyke DA (1985). Height at diagnosis of diabetes in children: a study in identical twins. British Medical Journal, 290: Blom L, Persson LA & Dahlquist G (1992). A high linear growth is associated with an increased risk of childhood diabetes mellitus. Diabetologia, 35: Sterky G (1967). Growth pattern in juvenile diabetes. Acta Paediatrica Scandinavica, 56 (Suppl 177): Dunger DB (1995). Diabetes and the endocrine changes of puberty. Practice Diabetes International, 129: Drayer NM (1974). Height of diabetic children at onset of symptoms. Archives of Disease in Childhood, 40: Salardi S, Tonioli S, Tassoni P, Tellarini M, Mazzanti L & Cacciari E (1987). Growth and growth factors in diabetes mellitus. Archives of Disease in Childhood, 62: Bognetti E, Riva MC, Bonfatti R, Meschi F, Viscardi M & Chiumello G (1998). Growth changes in children and adolescents with short-term diabetes. Diabetes Care, 21: Price DE & Burden AC (1992). Growth of children before onset of diabetes. Diabetes Care, 15: Emerson AJB & Savage DCL (1988). Height at diagnosis in diabetes. European Journal of Pediatrics, 147: Thon A, Heinze E, Feilen KD, Holl RW, Schmidt H, Koletzko S, Wendel U & Nothjunge J (1992). Development of height and weight in children with diabetes mellitus: report on two prospective multicentre studies, one cross-sectional, one longitudinal. European Journal of Pediatrics, 151: Leslie RDG, Lo S, Millward BA, Honour J & Pyke DA (1991). Decreased growth velocity before IDDM onset. Diabetes, 40: Dib SA, de Sá JR, Calliari LEP, Aguadé LCM, Russo EMK & Chacra AR (1993). Aspectos da fase não-insulinodependente do DM1. Revista da Associação Médica Brasileira, 39: Blethen SL, Sargeant DT, Whitlow MG & Santiago JV (1981). Effect of pubertal stage and recent blood glucose control on plasma somatomedin C in children with insulin-dependent diabetes mellitus. Diabetes, 30: Cook JS, Hoffman RP, Stene MA &

9 Development according to pubertal stage in children with diabetes 1323 Hansen JR (1993). Effects of maturational stage on insulin sensitivity during puberty. Journal of Clinical Endocrinology and Metabolism, 77: American Diabetes Association (1998). Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (Committee Report). Diabetes Care, 21: S5-S Hammer LD, Kraemer HC, Wilson DM, Ritter PL & Dornbusch SM (1991). Standardized percentile curves of body-mass index for children and adolescents. American Journal of Diseases of Children, 145: Marshall WA & Tanner JM (1969). Variations in the pattern of pubertal changes in girls. Archives of Disease in Childhood, 44: Marshall WA & Tanner JM (1970). Variations in the pattern of pubertal changes in boys. Archives of Disease in Childhood, 45: Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF & Moore WM (1979). Physical growth: National Center for Health Statistics percentiles. American Journal of Clinical Nutrition, 32: Sawaya AL, Grillo LP, Verreschi IT, da Silva AC & Roberts SB (1998). Mild stunting is associated with higher susceptibility to the effects of high fat diets: studies in a shantytown population in São Paulo, Brazil. Journal of Nutrition, 128: 415S-420S. 21. Vieira JGH, Nishida SK, Pereira AB, Arraes RF & Verreschi ITN (1994). Serum levels of prostate-specific antigen in normal boys throughout puberty. Journal of Clinical Endocrinology and Metabolism, 78: Hauane B (1962). Growth in a series of diabetic children on identical treatment with free diet and insulin. Acta Paediatrica Scandinavica, 51: INAN (Instituto Nacional de Alimentação e Nutrição) (1990). Pesquisa Nacional sobre Saúde e Nutrição. Perfil de Crescimento da População Brasileira de 0 a 25 Anos. Ministério da Saúde. Brasília. 24. Eisenbarth GS, Connelly J & Soeldner JS (1987). The natural history of type 1 diabetes. Diabetes/Metabolism Reviews, 3: Zachrisson I, Brismar K, Hall K, Wallensteen M & Dahlqvist G (1997). Determinants of growth in diabetic pubertal subjects. Diabetes Care, 20: Suikkara A, Koivisto VA, Koistinen R, Seppala M & Hannele Y (1989). Doseresponse characteristics for suppression of low molecular weight plasma insulinlike growth factor-binding protein by insulin. Journal of Clinical Endocrinology and Metabolism, 68: Danne T, Kordonouri O, Enders I & Weber B (1997). Factors influencing height and weight development in children with diabetes. Diabetes Care, 20: Veiga GV & Sigulen DM (1994). Avaliação da composição corporal através de medidas antropométricas, de adolescentes obesas e eutróficas de dois níveis sócioeconômicos. Journal of Pediatrics, 70: Marques RM, Marcondes E, Berquó E, Prandi R & Yunes J (1982). Crescimento e Desenvolvimento Pubertário em Crianças e Adolescentes Brasileiros. II. Altura e Peso. Editora Brasileira de Ciências Ltda., São Paulo. 30. Dunger DB (1992). Diabetes in puberty. Archives of Disease in Childhood, 67: Peveler RC, Fairburn CG, Boller I & Dunger DB (1992). Eating disorders in adolescents with insulin-dependent diabetes mellitus: a controlled study. Diabetes Care, 15: Tatterssal RB & Pyke DA (1973). Growth in diabetic children: studies in identical twins. Lancet, ii: Clarke WL, Vance ML & Rogol AD (1993). Growth and the child with diabetes mellitus. Diabetes Care, 16: Cuttler GB, Cassola FG, Ross JL, Pescovitz OH, Barnes KM, Feuillan PP, Laue L, Foster CM, Kenisberg D, Caruso-Nicoletti M, Garcia HB, Uriarte M, Hench KD, Skerda MC, Long LM & Loriaux LD (1986). Pubertal growth: physiology and pathophysiology. Recent Progress in Hormone Research, 42: