Oza Chirantap, Antani Misha, More Chidvilas, Mondkar Shruti, Khadilkar Vaman, Gondhalekar Ketan, Khadilkar Anuradha
Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.
Department of Pathology, B.J. Medical College, Ahmedabad, India.
J Pediatr Endocrinol Metab. 2023 Sep 25;36(11):1052-1060. doi: 10.1515/jpem-2023-0153. Print 2023 Nov 27.
Disorders of pubertal development are enlisted as associated conditions in children and adolescents with type-1 diabetes (T1D). We conducted this study with objective (1) To estimate the median age at onset of puberty and luteinizing hormone (LH) and sex-steroid concentrations in Indian adolescents with T1D and (2) To assess the impact of puberty on glycemic control and insulin resistance (IR).
This cross-sectional study included 399 children and youth aged 6-23 years with T1D. Demographic, anthropometric, biochemical and pelvic ultrasound data were collected using standard protocols. IR was calculated using estimated glucose disposal rate and puberty was assessed using Tanner staging.
Median age at onset of thelarche, pubarche and menarche were 11.3, 11.4 and 12.8 years in girls and that of gonadarche and pubarche were 10.6 and 12.7 years for boys. The mean LH and sex-steroid concentrations of subjects with T1D were similar to healthy subjects at each stage of puberty. The cut-offs of LH and sex-steroids derived from healthy Indian children yielded high sensitivity and specificity in determining pubertal onset. The prevalence of precocity, delayed puberty, ovarian cysts and polycystic ovaries was 0.9 , 5.1, 5.1 and 8.6 %, respectively. Glycaemic control and insulin sensitivity was poor in pubertal subjects.
The age at onset of puberty, LH, and sex-steroid concentrations in subjects with T1D were like otherwise healthy Indian children with poor glycemic control and IR in pubertal subjects. Although most complications of T1D are associated with poor glycemic control, pubertal disorders were significantly low despite the less-than-optimal glycemic control.
青春期发育障碍被列为1型糖尿病（T1D）儿童和青少年的相关病症。我们开展本研究的目的是：（1）估计印度T1D青少年青春期开始的中位年龄以及促黄体生成素（LH）和性类固醇浓度；（2）评估青春期对血糖控制和胰岛素抵抗（IR）的影响。
这项横断面研究纳入了399名6 - 23岁的T1D儿童和青少年。使用标准方案收集人口统计学、人体测量学、生化和盆腔超声数据。使用估计的葡萄糖处置率计算IR，并使用坦纳分期评估青春期。
女孩乳房发育、阴毛发育和月经初潮开始的中位年龄分别为11.3岁、11.4岁和12.8岁，男孩性腺发育和阴毛发育开始的中位年龄分别为10.6岁和12.7岁。T1D受试者在青春期各阶段的平均LH和性类固醇浓度与健康受试者相似。源自健康印度儿童的LH和性类固醇临界值在确定青春期开始时具有高敏感性和特异性。性早熟、青春期延迟、卵巢囊肿和多囊卵巢的患病率分别为0.9%、5.1%、5.1%和8.6%。青春期受试者的血糖控制和胰岛素敏感性较差。
T1D受试者青春期开始的年龄、LH和性类固醇浓度与其他健康的印度儿童相似，青春期受试者血糖控制和IR较差。虽然T1D的大多数并发症与血糖控制不佳有关，但尽管血糖控制未达最佳，青春期障碍的发生率仍显著较低。
