23 (1994) 55-57
Height at onset of insulin-dependent diabetes in children in Southern India A. Ramachandran*,
T. Annie Joseph,
V. Vijay, M. Viswanathan
Diabetes Research Centre and M. V. Hospital for Diabetes, 5 Main Road, Royapuram. Madras 600 013. India
Abstract A total of 250 children with insulin-dependent diabetes mellitus (IDDM), having age at onset of diabetes 5 18 years were studied. Their height at onset of diabetes was compared with that of the normal age- and sex-matched control population. No differences were observed in the heights of the two groups of children. Therefore, our results were similar to that found in Japan and differed from the reports in European children with IDDM in whom an increased growth velocity was noted before the onset of IDDM.
Key words: IDDM; Diabetes in children; Height at onset of diabetes
The wide geographical variations seen in the prevalence of insulin dependent diabetes (IDDM) is attributed to the interaction of genetic and environmental factors [ 11. Some studies have analysed the growth rate of Caucasian children who developed IDDM and the results have been at variance, showing that they are tall [l-5], normal [6,7] and short . Interestingly, differences in growth velocity and height have also been reported in children developing IDDM, between high and low risk countries [ 1,2]. A recent report showed that in a high-risk white population in Pittsburgh, the * Corresponding author.
height of children at the onset of IDDM is reported to be greater compared with a matched control group [l-4] whereas in Japan, with low risk of IDDM, no such differences are noted [l]. In India, the prevalence of IDDM is low compared to the European population . Therefore, we studied the height of the IDDM children at the onset of the disorder and compared the results with standard data obtained in a matched group of children. 2. Study subjects The study registry of the the details of The inclusion
0168-8227/94/$07.00 0 1994 Elsevier Science Ireland Ltd. All rights reserved. SSDI 0168-8227(93)00836-6
subjects came from the IDDM Diabetes Research Centre, Madras, which are discussed elsewhere . criteria for this study were age at
A. Ramachandran et al. /Diabetes Res. Clin. Pratt. 23 (1994) 55-57
onset s 18 years and registration at the Diabetes Research Centre within 3 months of diagnosis. Of the 250 children, 125 were boys and 125 girls. All of them had acute onset of hyperglycaemia and were ketosis-prone in fasting state if insulin was withdrawn. The mean glycosylated haemoglobin
(HbAt) was 10.8 f 1.8% (SD.) at the first visit, The age distribution was as follows: l-5 years, n = 48; 6-11 years, n = 87; and 12- 18 years, n = 115. Height and weight at the first visit was taken as the measurements at onset of IDDM. The children were from different income group families
IDDM - BOYS
16 17 I8
AGE -YEARS c]
IDDM - GIRLS
HT (CMS) i""l-
AGE -YEARS C]NORMAL
Fig. 1. The height of the diabetic
at the time of diagnosis,
et al. /Diabetes
Res. clin. Pratt.
and were representative of the socioeconomic groups in the general population. A standard height chart for the children of the age-group studied was available from the reports of the Indian Council of Medical Research [lo].
3. Results and conclusions Fig. 1 shows the comparative mean heights of the children with IDDM and normal children, in boys and girls separately. The heights in children with IDDM were similar to the normal children in all age groups, in both sexes. As the heights in the diabetic and non-diabetic children were very similar, no statistical analysis was warranted. Conflicting reports had been published regarding height at diagnosis of IDDM in young Caucasians, some reporting the diabetic children being taller than normal children while others had noted they could be shorter or of normal height [l-7]. Blom et al. from Sweden showed that a high linear growth is associated with an increased risk of childhood diabetes (21. This growth velocity prior to diagnosis was regarded as a marker for IDDM and was attributed to the early lesions of beta cells evoking an over-compensation or an early remission type phase with hyperinsulinism [l I]. In a study of twin pairs, Hoskins et al. reported that half of the affected twins were shorter and the others were of the same height as that of their unaffected co-twins . Retarded growth was considered to be due to metabolic abnormalities associated with slow onset of diabetes. It was also suggested that the autoimmune pathology of IDDM might also influence the growth rate . A recent report described that the growth velocity could be different in IDDM children in high and low risk populations. This had been illustrated in a study comparing the height at onset of IDDM in children from Japan and Pittsburgh, USA [l]. This study found abnormal tallness of children diagnosed before puberty and abnormal shortness of those diagnosed after puberty in Pittsburgh. This phenomenon was conspicuously absent in IDDM children from Japan where the IDDM children had no difference in height compared with normal children. The obvious difference in
the phenomenon between the European IDDM children (Sweden and Pittsburgh) and the Japanese IDDM children was suggested to be due to the many-fold difference in the incidence of IDDM between the populations. The explanation seems true, as the results of our study in Indian IDDM children are similar to the Japanese children, two populations with a low prevalence of IDDM [ 1,8]. Therefore, the results lend further support to the contention that the growth velocity in children who develop diabetes is also dependent on the risk factors for the disorder and show differences between races with high and low risk for the disorder. 4. References I
Japan and Pittsburgh Groups (1989) Height
Childhood Diabetes Research at onset of insulin-dependent diabetes mellitus in high- and low-risk countries. Diab. Res. Clin. Pratt. 6, 173-176. Blom, L., Persson, L.A. and Dahlquist, G. (1992) A high linear growth is associated with an increased risk of childhood diabetes mellitus. Diabetologia 35, 528-533.
White. P. (1960) Childhood diabetes. Its course and influence on the second and third generations, Diabetes 9. 345-355.
Edelsten. A.D., Hughes, LA., Oakes, S.. Gordon, I.R.S. and Savage, D.C.L. (1981) Height and skeletal maturity in children with newly-diagnosed juvenile-onset diabetes. Arch. Dis. Child. 56, 40-44.
Drayer, N.M. (1974) Height of diabetic children at onset of symptoms. Arch. Dis. Child. 49. 616-620. Hoskins, P.J., Leslie. R.D. and Pyke, D.A. (1985) Height at diagnosis of diabetes in children: a study in identical
twins. Br. Med. J. 260. 278-280. Cout. S., Parkin, M.. Roberts, D.F. and Wentwel. J. (1982) HLA antigens and growth in diabetic children. Ann. Hum. Biol. 9, 329-336.
Ramachandran. A.. Snehalatha, C.. Abdul Khader. O.M.S.. Annie Joseph, T. and Viswanathan. M. (1992) Prevalence of childhood diabetes in urban population in South India. Diab. Res. Clin. Pratt. I?. 227-231.
Ramachandran, A., Snehalatha, C.. Premila. L.. Mohan. V. and Viswanathan. M. (1990) Familial aggregation in Type 1(insulin dependent) diabetes mellitus: a study from South India. Diabetic Med. 7. 876-879.
Swaminathan. M. (1985) Advanced Text Book on Food and Nutrition, Vol. I. Bangalore Printing & Publishing Co., Bangalore. pp. 801-826. Evans, N., Robinson. V.P. and Lister, J. (1972) Growth
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