Poor glycemic control during pubertal period leads to reduced height in Type 1 diabetics, finds research

Type 1 diabetes is one of the most common chronic diseases of childhood. It is characterized by insulin deficiency due to autoimmune-mediated β-cell destruction. If not controlled, it can lead to potential micro and macrovascular complications and impaired linear growth. Research has shown that type 1 diabetes can affect growth and lead to impaired height velocity, with individuals reaching less than normal height in adulthood. Adequate glycemic control in type 1 diabetics is identified by expected growth in childhood and adolescence. As there are conflicting results on the final height, risk of short stature, and glycemic control, researchers conducted a study to assess the adult height outcomes across levels of glycemic control in children and adolescents with type 1 diabetes. They also investigated the effect of sex, age at disease onset, and timing of glycemic control with puberty.

A population-based Swedish cohort study was carried out by collecting data on glycemic control and height from specialist healthcare visits of all individuals with childhood-onset type 1 diabetes in the National Diabetes Register. The mean glycated hemoglobin levels were categorized based on the target values for glycemic control from the International Society for Pediatric and Adolescent Diabetes guidelines. It was categorized as suboptimal (glycated hemoglobin A_1c [HbA_1c] 53-75 mmol/mol [7.0-9.0%]) and poor (HbA_1c > 75 mmol/mol [>9.0%]) to optimal (HbA_1c < 53 mmol/mol [<7.0%]) glycemic control was compared to final adult height and the risk of short stature using linear and logistic regression.

Findings:

• Poor glycemic control was associated with lower final adult height by −2.91 cm for males and −1.83 cm for females.
• It was also associated with a higher risk of short stature in males but not in females.
• The risk of short stature in females was higher when type 1 diabetes was detected before puberty, and poor glycemic control occurred before puberty.
• Adult height was lower for males irrespective of their age at diabetes onset, but only if they had poor glycemic control during or after puberty.

Thus, the study concluded that lower adult height in males and females was due to poor glycemic control than normal glycemic control after the onset of type 1 diabetes. The study also found that females were more vulnerable to poor glycemic control during the prepubertal period, highlighting the importance of maintaining optimal glycemic control in pre- and during puberty. Researchers underscored the importance of maintaining optimal glycemic control to ensure normal growth in individuals with type 1 diabetes.

Further reading: Smew AI, Lundholm C, Gong T, Lichtenstein P, Sävendahl L, Almqvist C. Glycaemic control and adult height: a nationwide Swedish cohort study on childhood type 1 diabetes. J Clin Endocrinol Metab. Published online November 18, 2024. doi:10.1210/clinem/dgae809.