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

Level of physical activity and gene expression of IL-10 and TNF-α in children and adolescents with Type 1 diabetes

AIMS

The gene expressions of IL-10 and TNF-α have been identified as important factors of the clinical condition in type I diabetes mellitus (DM1). However, the effect of physical exercise on the expression of these markers is poorly understood. Our objective was to evaluate the relationship between the level of physical activity (LPA) and the gene expressions of IL-10 and TNF-α, as the relationship with glycemic control and insulin reserve in children and adolescents with DM1.

METHODS

108 participants (1-23 years), were divided into 4 groups: DM1 with ketoacidosis (KETO) (n = 15); Decompensated DM1 (DM1d) (n = 32); Compensated DM1 (DM1c) (n = 30); and healthy control (C) (n = 30). The level of physical activity (LPA) was classified as low active, active, and very active. So evaluated Fasting blood glucose, HbA1c, C-peptide, and gene expressions of IL-10 and TNF-α.

RESULTS

The increase in the level of physical activity significantly affected the expression of TNF-α in the DMd and C groups. The increase in LPA from low to active reduced the gene expression of IL-10; however, the increase in NAF from active to very active was associated with an increase in IL-10 gene expression. A very active LPA contributes to reducing HbA1c and an increase in C-peptide in the KETO group.

CONCLUSION

The increase in LPA demonstrated a significant effect on the improvement of IL-10 and TNF-α gene expression in the KETO and DMd groups; however, in the KETO group, improvements were also observed in the percentage of HbA1C and C-peptide.

Determining the timing of pubertal onset via a multicohort analysis of growth

Objective

Growth-based determination of pubertal onset timing would be cheap and practical. We aimed to determine this timing based on pubertal growth markers. Secondary aims were to estimate the differences in growth between cohorts and identify the role of overweight in onset timing.

Design

This multicohort study includes data from three Finnish cohorts—the Type 1 Diabetes Prediction and Prevention (DIPP, N = 2,825) Study, the Special Turku Coronary Risk Factor Intervention Project (STRIP, N = 711), and the Boy cohort (N = 66). Children were monitored for growth and Tanner staging (except in DIPP).

Methods

The growth data were analyzed using a Super-Imposition by Translation And Rotation growth curve model, and pubertal onset analyses were run using a time-to-pubertal onset model.

Results

The time-to-pubertal onset model used age at peak height velocity (aPHV), peak height velocity (PHV), and overweight status as covariates, with interaction between aPHV and overweight status for girls, and succeeded in determining the onset timing. Cross-validation showed a good agreement (71.0% for girls, 77.0% for boys) between the observed and predicted onset timings. Children in STRIP were taller overall (girls: 1.7 [95% CI: 0.9, 2.5] cm, boys: 1.0 [0.3, 2.2] cm) and had higher PHV values (girls: 0.13 [0.02, 0.25] cm/year, boys: 0.35 [0.21, 0.49] cm/year) than those in DIPP. Boys in the Boy cohort were taller (2.3 [0.3, 4.2] cm) compared with DIPP. Overweight girls showed pubertal onset at 1.0 [0.7, 1.4] year earlier compared with other girls. In boys, there was no such difference.

Conclusions

The novel modeling approach provides an opportunity to evaluate the Tanner breast/genital stage–based pubertal onset timing in cohort studies including longitudinal data on growth but lacking pubertal follow-up.

Distinct Patterns of Daily Glucose Variability by Pubertal Status in Youth With Type 1 Diabetes

OBJECTIVE

To evaluate glycemia and metrics of glucose variability in youth with type 1 diabetes, and to assess patterns of 24-h glucose variability according to pubertal status.

RESEARCH DESIGN AND METHODS

Metrics of glycemia, glucose variability, and glucose patterns were assessed by using 4 weeks of continuous glucose monitoring (CGM) data from 107 youth aged 8-17 years with type 1 diabetes for ≥1 year. Glucose values per hour were expressed as percentages relative to the mean glucose over 24 h for a 4-week period. Glucose data were compared on the basis of pubertal status-prepubertal (Tanner stage [T] 1), pubertal (T2-4), and postpubertal (T5)-and A1C categories (<7.5% [<58 mmol/mol], ≥7.5% [≥58 mmol/mol]).

RESULTS

Youth (50% female, 95% white) had a mean ± SD age of 13.1 ± 2.6 years, diabetes duration of 6.3 ± 3.5 years, and A1C of 7.8 ± 0.8% (62 ± 9 mmol/mol); 88% were pump treated. Prepubertal youth had a higher mean glucose SD (86 ± 12 mg/dL [4.8 ± 0.7 mmol/L]; P = 0.01) and coefficient of variation (CV) (43 ± 5%; P = 0.06) than did pubertal (SD 79 ± 13 mg/dL [4.4 ± 0.7 mmol/L]; CV 41 ± 5%) and postpubertal (SD 77 ± 14 mg/dL [4.3 ± 0.8 mmol/L]; CV 40 ± 5%) youth. Over 24 h, prepubertal youth had the largest excursions from mean glucose and the highest CV across most hours compared with pubertal and postpubertal youth. Across all youth, CV was strongly correlated with the percentage of time with glucose <70 mg/dL (<3.9 mmol/L) (r = 0.79; P < 0.0001).

CONCLUSIONS

Prepubertal youth had greater glucose variability independent of A1C than did pubertal and postpubertal youth. A1C alone does not capture the full range of glycemic parameters, highlighting the added insight of CGM in managing youth with type 1 diabetes.