Height at onset of insulin-dependent diabetes mellitus in high- and low-risk countries. Japan and Pittsburgh Childhood Diabetes Research Groups

Early postnatal growth in children with HLA-conferred susceptibility to type 1 diabetes

AIMS/HYPOTHESIS

An association between increased length/height and weight gain and risk of type 1 diabetes (T1D) has been reported in children. We set out to investigate the potential contribution of T1D human leukocyte antigen (HLA) risk genotypes to this association in two countries with a contrasting disease incidence.

METHODS

In Estonia and Finland, length and weight were monitored up to the age of 24 months in 688 subjects. According to their HLA genotypes, the children were divided into four groups, those with very high, high or moderate risk for T1D, as well as a neutral/control group. Relative length and weight (SDS) were assessed and compared at 3, 6, 12, 18 and 24 months using World Health Organization (WHO) growth curves.

RESULTS

The mean relative length at the age of 24 months was lower in the group with the very high risk HLA genotype compared to the controls (p < 0.05). The mean relative weight differed between those two groups at the age of 12, 18 and 24 months (p < 0.05). When Estonian and Finnish cohorts were analyzed separately, the relative length showed similar but non-significant trends in both countries, while in Estonia the changes in weight at some time points still remained significant (p < 0.05).

CONCLUSIONS

Children with the highest HLA-conferred risk for T1D gained less weight and length during the first 24 months of life, and this feature was more pronounced in the Estonian children.

Bone age corresponds with chronological age at type 1 diabetes onset in youth

OBJECTIVE

To our knowledge, only two controversial articles have reported the study of bone age at diagnosis in diabetic children. The aim of this study was to compare chronological age with bone age and to evaluate the impact of A1C on bone age in children at diagnosis of type 1 diabetes.

RESEARCH DESIGN AND METHODS

In 496 diabetic children, height was measured at diagnosis and height SD score was calculated using the British 1990 growth reference. Bone age was determined according to the Greulich and Pyle method, and A1C levels were measured.

RESULTS

Participants' height was normal for age and sex. No significant differences were found between chronological age and bone age, and there was no correlation between Delta (bone age - chronological age) and A1C.

CONCLUSIONS

This study showed that height and bone maturation among diabetic children are normal for age and sex and independent of A1C at diagnosis of type 1 diabetes.

[Growth of children with insulin-dependent diabetes. Study of 104 cases]

BACKGROUND

Results of studies of growth in children with diabetes mellitus are still conflicting. In a cross-sectional and longitudinal study, statural growth was analysed in a sample of diabetic children in order to specify its characteristics and relationship with various factors.

POPULATION AND METHODS

One hundred and four children (53 girls and 51 boys) with insulin-dependent diabetes for more than 3 years have been studied (age at onset and duration of diabetes, respectively, 6.4 +/- 4.1 and 8.5 +/- 4.8 in girls; 6.1 +/- 3.9 and 7.9 +/- 3.9 in boys; m +/- SD). A control group included 51 boys (age: 8.9 +/- 2.9) and 49 girls (age: 9.3 +/- 2.7). Data were collected every three months. Hemoglobin A1c was measured using high performance liquid chromatography (normal range: 5.0 +/- 1.0%; m +/- 2 DS).

RESULTS

At diagnosis, height (evaluated in SD) did not differ between diabetic children and controls. Three years before the onset of diabetes, boys were taller compared to controls (1.02 +/- 0.20 vs 0.41 +/- 0.17; P < 0.05; m +/- SEM). Children five years after the onset of disease were overweight compared to controls (girls: 0.96 +/- 0.16 vs 0.00 +/- 0.20; boys: 0.59 +/- 0.16 vs -0.04 +/- 0.15; P < 0.01; m +/- SEM). Longitudinal study showed a progressive decrease of mean growth velocity starting at least 2 years before the onset of diabetes and proceeding until the end of growth. From diagnosis to the end of height development, there was a growth loss of 0.66 SD in girls (p < 0.01) and 0.69 SD in boys (p < 0.05). This alteration of growth affected more clearly children who became diabetic before the onset of puberty, especially those with early-onset diabetes and bad metabolic control. Growth changes for the first 5 years of diabetes were significantly and negatively correlated with mean hemoglobin A1c levels (r = -0.57). Growth changes from the onset of diabetes to the end of growth were correlated with age at diagnosis, (boys: r = 0.73; girls: r = 0.37). During puberty, girls exhibited a reduced growth spurt, especially when they were overweight and received too low doses of insulin.

CONCLUSIONS

On the whole, diabetic children were growing in normal range. Growth was adversely and mainly affected by early-onset diabetes, a long duration of disease, many years of poor metabolic control and, especially in adolescent girls, low doses of insulin and weight excess.

Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in Japanese children

The overall annual IDDM incidence rates by area in Japan for 1985-1989 for children 0-14 years of age at diagnosis were from 1.65 to 2.07 per 100,000. The incidence in males and females did not show any temporal trends during the period between 1980 and 1989. The prevalence of IDDM was about 1 per 10,000. The clinical features at diagnosis among Japanese IDDM children identified during the 2-year period between 1979 and 1980 were as follows. Fourteen percent of the cases were in coma and 12% of the cases were asymptomatic at diagnosis. There is a suggestion that slow onset IDDM is often seen in Japan. In these children, the decline of serum CPR levels and the prevalence of ICA (islet cell antibodies) over the course of diabetes was slower than in those with an abrupt onset classical IDDM. During the period from 1975 through 1990 the incidence rates of NIDDM in school children showed as much as an approximate 1.5-fold increase along with a similar increase in the prevalence of obesity. About eighty percent of these NIDDM children were obese. A predominance of female children developing diabetes was seen in both type of diabetes, IDDM and NIDDM, in Japan. Non-obese type NIDDM in children was more common in females than in males. It is interesting to note that the mean height of Japanese children with IDDM was not different from the national average, but children with NIDDM were significantly taller than the national average.

Height at onset of insulin-dependent diabetes in children in southern India

A total of 250 children with insulin-dependent diabetes mellitus (IDDM), having age at onset of diabetes < or = 18 years were studied. Their height at onset of diabetes was compared with that of the normal age- and sex-matched control population. No differences were observed in the heights of the two groups of children. Therefore, our results were similar to that found in Japan and differed from the reports in European children with IDDM in whom an increased growth velocity was noted before the onset of IDDM.

Clinical and laboratory features of type 1 diabetic children at the time of diagnosis

The French incidence study has registered all new cases of Type 1 diabetic children under 20 years of age, from a population of 2.32 million, in an exhaustive and prospective manner. Three hundred and forty cases were identified between 1 January 1988 and 31 December 1989, yielding a mean annual incidence rate 7.3 per 10(5). The lowest rate was observed in the youngest age group (0-4 yr: 4.1 per 10(5)) and the highest around pubertal development (10-14 yr: 11.5 per 10(5)). Details of the previous personal and family history, and the clinical and biological pictures of the disease at diagnosis were recorded. Almost 8 per cent of the children had a first-degree relative with Type 1 diabetes. Polyuria, weight loss, fatigue and abdominal pain were the most frequently reported symptoms, which were of median duration 4.4 months. Mean weight loss before diagnosis was 9.4 +/- 6.8 (+/- SD)% of body weight and was not significantly related to age. Ketonuria was detected in 83.8 per cent and acidosis (total CO2 less than or equal to 18 mmol l-1, if measured) in 48 per cent of the cases. Ketonuria and acidosis were significantly more frequent in the younger age group than in the rest of the group (p less than 0.001).

Descriptive epidemiology of non-insulin dependent diabetes mellitus detected by urine glucose screening in school children in Japan

During the period from 1974 through 1988, we annually examined approximately 225,000 to 386,400 school children residing in Tokyo for glycosuria to detect juvenile diabetes. If the first test was positive for glucose, glycosuria was confirmed by a second test. In children who gave a positive result in both the first and second tests 0-GTT were performed. All 124 patients were diagnosed as NIDDM according to the criteria of the WHO Report on Diabetes of 1985. The incidence of NIDDM in children in Japan has increased in recent years and from 1984 to 1986 was approximately 3.8 per 100,000 per year. The frequency of NIDDM increases with age up to 14 years. In about 84% of cases, the body weight at diagnosis is more than 20% above the ideal weight and the height is often above average. There is a high frequency in families with a history of diabetes. Diet and exercise therapy in newly diagnosed patients irrespective of the presence or absence of obesity may result in remission, but some cases may require insulin therapy or oral administration of a hypoglycemic drug to obtain a better glycemic control. Children with NIDDM are more likely to be complicated by incipient retinopathy within two years after diagnosis than those with IDDM. Therefore, it is important to keep strict glycemic control to prevent diabetic complications in NIDDM children just as in juvenile onset IDDM.