Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts.
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
J Clin Endocrinol Metab. 2019 Jan 1;104(1):74-82. doi: 10.1210/jc.2018-01737.
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.
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.
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.
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.
评估青春期变化对于管理 1 型糖尿病等慢性儿科疾病非常重要。通常无法获得、不切实际或成本高昂的是对青春期状态进行身体和/或实验室评估。
开发和验证一种实用且客观的方法，通过 1 型糖尿病青少年的纵向线性生长来评估青春期状态。
设计、参与者和结果测量：参与者（n = 123）是一项为期 2 年的研究的一部分，该研究评估了一家三级糖尿病中心的 1 型糖尿病青少年的连续血糖监测。使用临床 Tanner 分期或电子病历中可用的青春期成熟指标，通过分层方法在就诊时分配青春期状态。对于其他就诊，身高速度和生长图表轨迹的独立评估为青春期状态分配提供了数据。敏感性分析证实了青春期状态分配的有效性。
该样本（50%女性，95%白人）的平均年龄为 12.7 ± 2.7 岁，糖尿病病程为 6.0 ± 3.6 年，血红蛋白 A1c 为 7.9 ± 0.8%。在 985 次研究就诊中，50%根据临床 Tanner 分期分配了青春期状态，29%根据额外的病历审查分配，22%根据身高速度和生长图表轨迹评估分配。对于敏感性分析，基于身高速度和生长图表轨迹的青春期状态分配在 87%的就诊中与临床 Tanner 分期匹配。
我们基于身高速度和生长图表轨迹评估青春期状态的实用和客观方法突出了生长作为青春期起始、状态和进展的可靠和客观生物标志物。
