Abstract Details

Session title: Diabetes in childhood and adolescence Session type: Poster - Epidemiology and Public Health Track: Epidemiology and Public Health

Presentation number: P-0777

Abstract title:

Growth and development trends in economically underprivileged type 1 diabetes children in India

Presenting Author: Sinha A K

Background

Though children with type 1 diabetes mellitus (T1DM) are often tall at the time of diagnosis, they may experience growth retardation, pubertal delay or both, which may be due to poor glycemic control, associated diseases or chronic complications. Factors affecting growth include: gender, genetic environment, age at diagnosis, diabetes duration, puberty, metabolic control, and status of growth hormone (GH), insulin-like growth factors (IGFs), and IGF binding proteins (IGFBPs).

Thyroid hormones (TH) are critical for early brain development, somatic growth, and bone and pubertal maturation. In many respects, (TH) may be viewed as tissue growth factors. Effects on growth and development are classified as genomic actions mediated via stimulation of mRNA for pituitary growth hormone (GH) synthesis, secretion and sensitivity. TH potentiate GH stimulation of the synthesis and action of insulin-like growth factor 1 (IGF1) and stimulation of the production of different growth factors (epidermal growth factor, nerve growth factor, and erythropoietin). Cartilage response to IGF1 and osteoblastic/osteoclastic bone remodeling are also regulated by thyroid hormones.

Aim

To analyze the longitudinal [2011-2017] growth and development characteristics of a cohort of economically under privileged children with type 1 diabetes [onset 1 - 18 Y] DISHA Free Clinic, India.

Method

DISHA: Beginning 1987, 2000 children provided free insulin and syringes, health counseling, 24 hour helplines. Since 2006, BG meters and 5-10 strips/month added. Basal bolus insulin [meal time regular plus bedtime NPH] 100%.

DISHA + CDiC/LFAC: 2011- ongoing: [Changing Diabetes in Children and Life for a Child with Diabetes] 242 children are receiving enhanced material support -100 BG strips per month, limited biochemical evaluations [TSH, quarterly HbA1c testing, annual urine albumin: creatinine ratio].

Initial = At enrollment to DISHA + LFAC/CDIC

Latest = At latest follow up

Follow up 2 years [Mean]

Height [Ht] = Cms and Percentile [%] 

Weight [Wt] = Kgs and Percentile [%]

Height percentile [%] A Delta = Latest versus initial height percentile

Height SDS A Delta = Latest versus initial height SDS 

Weight SDS A Delta = Latest versus initial weight SDS

Results

Age onset T1DM: 9.6 y; 0-5 y: 20%; 6-10 y: 34%; 11-15 y: 39%; 16-18 y: 7%. Duration of Diabetes: 8.6 y; Rural : Urban = 48 : 52.

Growth Groups Age yInitial Ht % Initial Ht SDSHt SDS ATSH uU/ mlHypo thyroid % new
Improved 26 % 14	19	 -1.2	0.75	2.0	0
Stable 64%	15	12	-2.1	0.69	4.0	6
Decline 10%	10	35	-0.5	-0.9	10.0	33


'Growth decline" was associated with younger age [prepubertal], better initial height and weight SDS and a higher prevalence of newly diagnosed hypothyroidism. On follow up, this group demonstrated, worst improvement (decline) in height and weight SDS and lesser improvement of HbA1c.

Discussion

Growth faltering in T1DM children is thought to be related to impairment of the GH/IGF-1 axis, but children with T1DM are also more at risk of hypothyroidism and coeliac disease. At puberty, persisting abnormalities of the GH/IGF-1 axis and our inability to reverse these totally, even with intensified insulin therapy, contribute to the blunted pubertal growth. In the economically underprivileged segment of the society, malnutrition and protein calorie deprivation will be contributory factors. Thus, close monitoring of growth and puberty, and prompt rectification of the pathogenetic deficits are critical to ensure optimal health and achievement of these future citizens.