Areekal Sandra Aravind, Khadilkar Anuradha, Goel Pranay, Cole Tim J
Department of Biology, Indian Institute of Science Education and Research, Pune 411008, India.
Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune 411001, India.
Pediatr Diabetes. 2023 Jul 1;2023:8813031. doi: 10.1155/2023/8813031. eCollection 2023.
Height growth is affected by longterm childhood morbidity.
To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without diabetes, and to see how parental height and disease severity affect the growth pattern. . The data came from: (i) the Sweetlings T1DM (STDM) study with 460 subjects aged 4-19 years, previously diagnosed with T1DM and followed for 2-6 (median 3) years, with repeat measurements of height and glycated hemoglobin (HbA1c), and (ii) the Pune School-Children Growth (PSCG) study with 1,470 subjects aged 4-19 years, and height measured annually for median 6 years. Height growth was modeled using SuperImposition by Translation and Rotation (SITAR), a mixed effects model which fits a cubic spline mean curve and summarizes individual growth in terms of differences in mean size, and pubertal timing and intensity.
SITAR explained 99% of the variance in height, the mean curves by sex showing that compared to controls, the children with diabetes were shorter (by 4/5 cm for boys/girls), with a later (by 1/6 months) and less intense (-5%/-10%) pubertal growth spurt. Adjusted for mean height, timing and intensity, the diabetic and control mean curves were very similar in shape. SITAR modeling showed that mean HbA1c peaked at 10.5% at age 15 years, 1.0% higher than earlier in childhood. Individual growth patterns were highly significantly related to parental height, age at diabetes diagnosis, diabetes duration, and mean HbA1c. Mean height was 3.4 cm more per + 1 SD midparental height, and in girls, 2 cm less per + 1 SD HbA1c.
The results show that the physiological response to T1DM is to grow more slowly, and to delay and extend the pubertal growth spurt. The effects are dose-related, with more severe disease associated with greater growth faltering.
儿童期长期发病会影响身高增长。
比较被诊断为1型糖尿病（T1DM）的印度儿童与无糖尿病儿童对照组的生长曲线，并观察父母身高和疾病严重程度如何影响生长模式。数据来自：（i）Sweetlings T1DM（STDM）研究，有460名4至19岁的受试者，之前被诊断为T1DM，并随访2至6年（中位数为3年），对身高和糖化血红蛋白（HbA1c）进行重复测量；（ii）浦那学童生长（PSCG）研究，有1470名4至19岁的受试者，每年测量身高，中位数为6年。身高增长采用平移和旋转叠加法（SITAR）进行建模，这是一种混合效应模型，拟合三次样条平均曲线，并根据平均大小差异、青春期时间和强度总结个体生长情况。
SITAR解释了身高变异的99%，按性别划分的平均曲线显示，与对照组相比，糖尿病儿童更矮（男孩/女孩分别矮4/5厘米），青春期生长突增更晚（晚1/6个月）且强度更低（-5%/-10%）。在调整了平均身高、时间和强度后，糖尿病组和对照组的平均曲线在形状上非常相似。SITAR建模显示，平均HbA1c在15岁时达到峰值10.5%，比儿童早期高1.0%。个体生长模式与父母身高、糖尿病诊断年龄、糖尿病病程和平均HbA1c高度显著相关。每增加1个标准差的父母平均身高，平均身高增加3.4厘米，而在女孩中，每增加1个标准差的HbA1c，平均身高减少2厘米。
结果表明，对T1DM的生理反应是生长更缓慢，青春期生长突增延迟并延长。这些影响与剂量相关，疾病越严重，生长发育迟缓越明显。
