Determination of Pubertal Status in Youths With Type 1 Diabetes Using Height Velocity and Trajectories

Abstract

Context: Assessment of pubertal change is important for the management of chronic pediatric diseases, such as type 1 diabetes. Physical and/or laboratory assessments of pubertal status are often unavailable, impractical, or costly.

Objective: To develop and validate a practical and objective method to assess pubertal status using longitudinal linear growth in youths with type 1 diabetes.

Design, participants, and outcome measurements: Participants (n = 123) were part of a 2-year study assessing continuous glucose monitoring in youths with type 1 diabetes at a tertiary diabetes center. Pubertal status at visits was assigned by a tiered approach using clinical Tanner staging or indicators of pubertal maturation from the electronic medical record when available. For other visits, independent evaluations of height velocities and growth chart trajectories provided data for pubertal status assignments. Sensitivity analysis confirmed the validity of the pubertal status assignments.

Results: The sample (50% female, 95% white) had a mean ± SD age of 12.7 ± 2.7 years, diabetes duration of 6.0 ± 3.6 years, and hemoglobin A1c of 7.9 ± 0.8%. Of 985 study visits, 50% received a pubertal status assignment based on clinical Tanner staging, 29% on additional medical record review, and 22% on an evaluation of height velocity and growth chart trajectory. For the sensitivity analysis, pubertal status assignments based on height velocity and growth chart trajectory matched clinical Tanner staging in 87% of visits.

Conclusions: Our practical and objective method to assess pubertal status based on height velocity and growth chart trajectory highlights growth as a reliable and objective bioassay for pubertal onset, status, and progression.

Figure 1.

Growth curve example of growth trajectories during pubertal maturation, including height trajectories typically observed during prepubertal, pubertal, and postpubertal maturation in a female participant.

Figure 2.

Growth curves illustrating discrepancies between pubertal status assignments by height velocity calculation and growth curve review. (a and b) A boy (a) and a girl (b) in whom the discrepancy is attributed to brief periods of seemingly irregular growth, likely due to errors in height measurements. (c and d) A boy (c) and a girl (d) in whom the discrepancy is attributed to transition periods between pubertal statuses. Arrows depict study visits without clinical Tanner staging that required pubertal status assignments by height velocity (HV) calculation and growth curve review. Pubertal status assignments by each method are shown in the tables for each growth curve, with “Adjudication Assignment” as the final pubertal status assigned after adjudication.