Blasetti Annalisa, Castorani Valeria, Polidori Nella, Mascioli Ilaria, Chiarelli Francesco, Giannini Cosimo
Department of Paediatrics, University of Chieti, Chieti, Italy.
Endocr Connect. 2023 Mar 28;12(4). doi: 10.1530/EC-22-0370. Print 2023 Apr 1.
Linear growth is impaired in children with type 1 diabetes (T1D) and poor metabolic control. A good metabolic control is a key therapeutic goal to prevent vascular complications and also to ensure appropriate anthropometric development during childhood. In this study, we aimed to identify and characterize the effects of glycemic variability on linear growth in children with T1D.
Data from 144 prepubertal children with T1D were evaluated. Anthropometric measurements (weight, weight-SDS, height, height-SDS, BMI, BMI-SDS) were collected and glycosylated hemoglobin (HbA1c) was measured at admission and every 4 months over a 2-year period. Glycemic variability indexes (glycemic coefficient of variation (CV), glycemic CV percentage (CV%), and the product between HbA1c-mean and HbA1c-SDS/100 (M*SDS-HbA1c/100)) were calculated. According to height-SDS changes after 2 years of follow-up, the study population was divided into three tertile groups and differences across groups were investigated for variables of interest.
The three groups were similar in terms of age, gender, and follow-up period. After 2 years, all prepubertal children showed a significant positive trend of anthropometric data. Across the three tertile groups, HbA1c-SDS, CV, CV%, and MSDS-HbA1c significantly decreased from the first to the third tertile of height-SDS. During follow-up, children with lower Δheight-SDS values reported higher values of HbA1c-SDS, CV, CV%, and MSDS-HbA1c than subjects with higher linear growth.
Glycemic variability correlates with linear growth in children with T1D. Low glycemic variability indexes were reported in higher height-SDS tertiles. Δheight-SDS is inversely correlated with glycemic CV, CV%, and M*SDS-HbA1c.
1型糖尿病（T1D）患儿且代谢控制不佳时线性生长会受损。良好的代谢控制是预防血管并发症以及确保儿童期适当人体测量学发育的关键治疗目标。在本研究中，我们旨在确定并描述血糖变异性对T1D患儿线性生长的影响。
对144名青春期前T1D患儿的数据进行评估。收集人体测量数据（体重、体重标准差分值（SDS）、身高、身高SDS、体重指数（BMI）、BMI-SDS），并在入院时以及2年期间每4个月测量糖化血红蛋白（HbA1c）。计算血糖变异性指标（血糖变异系数（CV）、血糖CV百分比（CV%）以及HbA1c均值与HbA1c-SDS/100的乘积（M*SDS-HbA1c/100））。根据随访2年后身高SDS的变化，将研究人群分为三个三分位数组，并对感兴趣的变量进行组间差异研究。
三组在年龄、性别和随访时间方面相似。2年后，所有青春期前儿童的人体测量数据均呈现显著的正向趋势。在三个三分位数组中，HbA1c-SDS、CV、CV%和MSDS-HbA1c从身高SDS的第一个三分位数到第三个三分位数显著降低。在随访期间，Δ身高-SDS值较低的儿童报告的HbA1c-SDS、CV、CV%和MSDS-HbA1c值高于线性生长较高的受试者。
血糖变异性与T1D患儿的线性生长相关。较高身高SDS三分位数组的血糖变异性指标较低。Δ身高-SDS与血糖CV、CV%和M*SDS-HbA1c呈负相关。
