Factors Influencing Height and Weight Development in Children With Diabetes: Results of the Berlin Retinopathy Study

Abstract

OBJECTIVE To investigate the influence of glycemic control and insulin therapy on the longitudinal growth and weight development of children with diabetes. RESEARCH DESIGN AND METHODS Prospective measurements of standing height and weight were recorded longitudinally in 634 children after IDDM onset (median age at onset, 9 years [range 1–15 years]; median diabetes duration at final examination, 11 years [range 1–19]; 3,236 patient-years on two or three injections daily; 399 patient-years on multiple injection therapy [MIT]). RESULTS Normal development was found until puberty, with a tendency toward stunted growth and overweight (weight > 97th centile) thereafter. Female sex (P < 0.01) and MIT (P < 0.01) were associated with overweight. Final height was evaluated in a subgroup of 197 young adults followed until age 18 years. Relative growth was calculated as the difference between the standard deviation scores (SDSs) at manifestation (median 0.2 [range −3.5 to 2.9]) and at 18 years of age (reduction of −0.5 [−2.5 to 1.8]), equivalent to a median loss of 2.9 cm in boys and 2.3 cm in girls. Significant linear correlations with the change in height SDS after diabetes manifestation were found for age at manifestation (r = 0.21, P < 0.001) and prepubertal (r = −0.40, P < 0.001) and postpubertal HbA1c (r = −0.15, P < 0.001). While children with poorer relative growth also had a higher BMI (P < 0.05), no influences of sex, prevalence of limited joint mobility, or presence of retinopathy were found. CONCLUSIONS Female sex and MIT are associated with diabetes-related obesity. Prepubertal and postpubertal glycemic control appear to be of importance for the diabetes-associated relative growth deficit.