Secular trends in growth in diabetes: are we winning?

Abstract

Aim: To determine potential effects of modern treatment on growth in diabetic children.

Methods: Retrospective analysis of growth in diabetic children stratified by their year of diagnosis between 1974 and 1995. A total of 451 children and adolescents attending the Diabetes Outpatient and Outreach Clinics of Royal Alexandra Hospital for Children in Sydney and rural NSW, Australia were studied. Standard deviation scores (SDS) for height and body mass index (BMI) were assessed at diagnosis, five years later (n = 451), and 10 years later (n = 111).

Results: After five years of diabetes duration height SDS loss correlated with higher HbA(1c) and fewer injections. BMI SDS gain correlated with HbA(1c) and age at diagnosis. Although there was no significant difference in their height SDS or age at diagnosis, children diagnosed 1974-90 were significantly shorter than children diagnosed 1991-95 (height SDS 0.07 v 0.37) after five years diabetes duration. Furthermore, over 5 and 10 years, the 1979-90 group had lost significant height SDS (mean change -0.20 at 5 years, -0.29 at 10 years); this did not occur in the 1991-95 group (-0.01 at 5 years, -0.13 at 10 years). The BMI SDS increased significantly after 10 years in the 1974-90 group (mean change 0.37) but not in the 1991-95 group. There was no significant difference in the 174 females' age of menarche (13.0 v 12.8 years).

Conclusions: Children with diabetes treated with modern regimens maintain their increased height from diagnosis better, and after five years diabetes duration, were taller than children diagnosed before 1991.

Figure 1

Height SDS of children with diabetes mellitus over a study period of 10 years after diabetes onset, stratified by year of diagnosis. The mean and 95% confidence limits are shown.

Figure 2

BMI SDS of children with diabetes mellitus over a study period of 10 years after diabetes onset, stratified by year of diagnosis. The mean and 95% confidence limits are shown.