A Statistical Study of the Rate of Skeletal Growth in Juvenile Diabetes

Abstract

The results of this study are recorded, not because we are convinced that the findings will apply to a much larger series of cases, but in order that they may be tested by others with similarly available data.A short time ago Priscilla White", working in Joslin's clinic at Boston, made the interesting observation that children with diabetes tend to be overheight, and suggested a causal relationship between rate of skeletal growth and diabetes. Though height and weight measurements are made as a routine in our clinic for diabetes, we had not observed this. On investigating our cases, however, the above mentioned relationship appeared to hold good. Of seventy-one children, forty were over-height, with respect to their ages on admission to the clinic. An interesting observation was that, taken as a whole, the average rate of growth of these diabetic children after treatment was instituted was less than the normal. From this observation alone, it appeared that whatever the stimulus which produces diabetes in the child may be, it also causes excess skeletal growth. This was further suggested by the fact that when all children were grouped with respect to their heights on admission to our clinic, namely, (a) those who were.over-height, and (b) those who were normal or under-height, the average rate of growth of those of the former group was distinctly less than those of the latter.It is obvious that in a study involving skeletal growth there are many variables to consider and not all of these are readily controllable. For example, standards of measurement vary. A glance at any two of the available tables, selected at random, is evidence of this fact. An equally important consideration is the magnitude of the number of observations possible in any one clinic. In our clinic, as probably in others, children represent only about five per cent. of the total number of diabetics. Of all the variables, the above mentioned appeared to be of the greatest importance and an attempt was made to overcome them in the following manner:In the seventh edition of his book on Diseases of Infancy and Childhood, Holt gives two tables with reference to age-height-weight-sex relationships. One of these is concerned with average net heights and weights of healthy children from birth to four years. The other table records average annual rates of increase of height and weight from five to fifteen years. The reason the writer has selected these data as standard is that they are based upon measurements made by ten different authors. In view of the variability of such a factor as body height, it is reasonable to assume that the values given in such a compilation are more likely to approximate to true averages than those based upon experience from any one source,

Growth and Bone Age of Juvenile Diabetics

“…However, it has also been noted that diabetics, especially males, have a lower than normal height distribution (Berqvist, 1954;Larsson and Sterky, 1962;Pond, 1970). A tendency to overheight at the time of diagnosis has also been observed (Rabinowitch and Bazin, 1929;Pond, 1970).…”

“…With the introduction of insulin, growth spurts following treatment were recorded in spite of diets low in calories and carbohydrates (Joslin et al, 1925). By providing more calories and adequately controlling the diabetes, normal growth rates were in general obtained (Boyd and Kantrow, 1938;Brown and Thompson, 1940;Jackson and Kelly, 1946), though this was not a universal finding (Fischer, 1929;Rabinowitch and Bazin, 1929;Beal, 1948). In a large series of 1407 juvenile diabetics reported by Wagner, White, and Bogan (1942), 118 (8 3 %) were stunted.…”

Growth of Children with Type 1 Diabetes Mellitus

“…It was first noted in the 1920’s that diabetic children have a tendency to be “over−height” on admission compared to normal children (10). In later years, conflicting results have been reported in over 30 studies on growth of children with T1DM.…”

“…At the time of diagnosis, our patients (both males and females) were significantly taller compared to their genetic target heights and slightly taller compared to reference values. It was first noted in the 1920’s that diabetic children have a tendency to be “over−height” on admission compared to normal children ( 10 ). In later years, conflicting results have been reported in over 30 studies on growth of children with T1DM.…”