الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY ype 1 diabetes mellitus (T1DM) is one of the most common chronic metabolic disorders in children and adolescents and its incidence is increasing worldwide. It is considered a factor that potentially affects the onset of male and female puberty and pubertal development and maturity. The earlier its onset, the longer and more severe the disease, and the greater the repercussion on growth and pubertal development. Puberty is characterized by important physiological and hormonal changes. In type 1 diabetes, abnormalities in the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis play an important role. Reduced IGF-1 levels in patients with poor glucose control may contribute to complications such as poor linear growth and low bone mineral content given that IGF-1 is a major anabolic regulator of bone growth and metabolism. The aim of the present study was to assess the anthropometric measures and pubertal growth of children and Adolescents with T1DM regularly attending Pediatric and Adolescents Diabetes Clinic, Ain Shams University and detect risk determinants affecting these measures and their link to glycemic control. T Summary 123 This was Cross-Sectional Observational study, conducted on 200 patients at Pediatric and adolescent diabetology outpatient Clinic, Children’s Hospital, Ain Shams University during a period of Six months. All patients with delayed growth were subjected to: IGF 1 for detection of growth hormone affection, Anti-tissue transglutaminase IgG and IgA for detection of Celiac disease, radiological evaluation by plain x ray on left hand and wrist & Bone age were done. Patients with delayed puberty were evaluated by detection of sex hormones (LH, FSH and testosterone) basal and after stimulation. The main results of the study revealed that: In our study we found that the prevalence of short stature among our studied cases was (12.5%), females compared to males (60 % versus 40% respectively). In our study we found that the prevalence of delayed puberty was (7.5%), females compared to males (86.7 % versus 13.3 % respectively). Short stature diabetic patients have significantly lower final Tanner score compared to those with normal stature patients. Diabetic patients with short stature have significantly higher HbA1C, FT4 and Albumin/creatinine ratio compared to those with normal stature diabetic patients. Meanwhile diabetic patients with short stature have lower Hb and MCV compared to those with normal stature diabetic patients. Summary 124 There is no significant difference between diabetic patients with short stature and those with normal stature regarding their basal and stimulated gonadotropin levels (FSH&LH), sex hormone levels (Testosterone & Estradiol). Patients with short stature have significantly lower IGF-1, IGF-1 SD and lower (delayed) bone age compared to those patients with normal stature. Patients with short stature have significantly higher incidences of cases with abnormal IGF- 1 (72%) and significantly lower incidence of cases with normal IGF-1 (28%). Diabetic patients with non-familial short stature have significantly earlier age of onset of diabetes, earlier age at diagnosis and longer duration of diabetes compared to those diabetic patients with normal stature and familial short stature. In diabetic patients with non-familial short the highest significant order of birth was the 3rd 6 (50.0%), while in diabetic patients with normal and familial short stature the highest significant order of birth was the 2nd 58 (30.9%), Diabetic patients with non-familial short stature have significantly lower Weight (kg), Wt. SDS, less Height (cm), Ht. SDS, BMI SDS, Waist circumference, WC SDS, Hip circumference and HipC SDS compared to those diabetic patients with normal stature and familial short stature. Summary 125 Diabetic patients with non-familial short stature have significantly higher HbA1C, Create, fasting cholesterol, TG, and Albumin/creatinine ratio compared to those with normal stature and familial short stature. Meanwhile diabetic patients with non-familial short stature have lower HB compared to those with normal stature and non-familial short stature. There is no significantly difference between diabetic patients with non-familial short stature and with those normal stature and familial short stature regarding their IGF- 1, IGF-1 SD and Bone age (yrs.). Diabetic patients with delayed puberty have significantly higher BMI SDS and W/Hip SDS compared to those patients with normal puberty. Meanwhile patients with delayed puberty have significantly lower Wt SDS, Ht. SDS, Waist circumference, Waist circumference SDS, Hip circumference and Hip circumference SDS compared to those diabetic patients with normal puberty. Diabetic patients with delayed puberty have significantly higher bone age (yrs.) compared to those diabetic patients with normal puberty. Prevalence of GDM in diabetic patients with normal IGF-1 (71.4%) and in diabetic patients with abnormal IGF-1 (25.0%). There was significantly increase in incidence of GDM among diabetic patients with normal IGF-1. Summary 126 Diabetic patients with normal IGF-1 have significantly higher Ht. SDS compared to those diabetic patients with abnormal IGF-1. Diabetic patients with normal IGF-1 have significantly lower WBC compared to those diabetic patients with abnormal IGF-1. Diabetic patients with normal IGF-1 have significantly higher incidence of Stimulated LH levels compared to those diabetic patients with abnormal IGF-1. Diabetic patients with delayed puberty and short stature have significantly higher abnormal IGF-1 compared to other two groups. there was significant positive correlation between IGF-1 and duration of diabetes (yrs.), Weight (kg), Height (cm), Ht. SDS, Waist circumference, Waist circumference SDS, Hip circumference, W/Hip SDS, Penile length (cm), Rt testicular volume (ml), Lt testicular volume (ml) and Final Tanner score. The best cut off point of IGF-1 SDS to detect Short stature was found ≤ -1.2 with sensitivity of 76%, specificity of 100.0%, PPV of 100.0%, NPV of 45.5% and total accuracy of 82.8%. The univariate logistic regression analysis shows that all the previous factors were significantly associated with short stature. Meanwhile the multivariate logistic regression Summary 127 analysis shows that the most significantly associated factors with short stature were Age at diagnosis, HbA1C >8.2 and Albumin/creatinine ratio >8. The univariate logistic regression analysis shows that all the previous factors were significantly associated with delayed puberty. Meanwhile the multivariate logistic regression analysis shows that the most significantly associated factors with delayed puberty were Ht. SDS <=-0.44, W/Hip SDS >1.92 and Breast volume. Based on our results we recommend further studies on larger patients and longer period of follow up to emphasize our conclusion. |