Effects of Glycemic Control on Growth and IGF-I, IGF-II, IGFBPs in Insulin dependent Diabetic Children

Kim, D H; Rho, K S; Chung, S C

Abstract

BACKGROUND: It is well known that linear growth velocity in diabetic children is closely related to metabolic control and age of onset. Many studies demonstrated growth impairment in diabetic children regardless of the degree of metabolic control, whereas other studies have found no growth retardation. We therefore compared growth status and growth factors in type I diabetic children with health children. METHODS: 50 patients with IDDM(27 F/23 M; mean age 12.4+4.6years)were studied. The mean duration of diabetes was 3.5+2.5years. The growth status and IGF-I, IGF-II, IGFBP-3 levels in type 1 diabetic children were comyared to those of age, sex-matched normal children(21 F/15 M; mean age 10.3+3.4 years). RESULTS: 1. HTSDS(height standard deviation score) in diabetic children was 0.2+1.1 and HTSDS in control 0.l+1.1. There is no significant difference in HTSDS between two groups. 2. Growth hormone in diabetic children was higher than control(3.1+1.7ng/mL in diabetes, vs 1.8 +2.3ng/mL in control, p<0.05). IGF-I and IGF-II levels in diabetes were lower than controls(IGF-I: 138.5+116.6ng/mL vs 232.7+190.4ng/mL, IGF-II: 552.0+178.5ng/mL vs 633.5+146.2ng/mL, p0.05). No significant difference in free IGF-I, IGFBP-1, IGFBP-3 between two groups. 3. HTSDS at onset of diabetes was 1.1+1.4 but HTSDS at study was much decreased to 0.2+1.3(p <0.05). Mean duration of diabetes was 3.5+ 2.5years. 4. HTSDS in diabetic children with less than 3 years duration was 0.6+1.0 and delta HTSDS was -0.4+0.8. HTSDS with more than 3 years duration was -0.2+1.5 and delta HTSDS was -1.2+1.3. HTSDS and delta HTSDS were much more decreased according to duration(p<0.01). 5. Delta HTSDS in diabetic children with poor control was significantly decreased(p<0.05). Delta HTSDS below 12% of HbAlc was -0.5+0.8 and delta HTSDS above 12% of HbAlc was -1.2+1.3. 6. Delta HTSDS was correlated with diabetic duration (r=0.50, p<0.01), There was no significant correlation between onset of age and HbAlc. Conclusions: The IGF-I dk. IGF-II levels were decreased in diabetic children compared with controls. HTSDS in diabetic children was not decreased compared to control, but delta HTSDS decreased with long duration of diabetes and poor metabolic control. There was no specific difference between diabetic control and serum concentration of free IGF-I, IGFBP-1 and IGFBP-3. These data suggest that the height of diabetic children could be impaired in case of long duration and poor metabolic control of diabetes.