Avaliação do crescimento linear em crianças com o diagnóstico de Diabetes Mellitus Tipo 1

Abstract

The Type 1 Diabetes Mellitus (T1DM) is characterized by the destruction of the ß-cells resulting in loss of endogenous insulin production. It is one of the most common presentations of youth-onset diabetes. The treatment needs multi-disciplinary approach and is based on intensive insulin therapy. The chronic hyperglycemia and severe insulin deficiency are known to be associated with impaired linear growth. The dysregulation of the GH-IGF-1 axis in T1DM is characterized by decreases in circulating IGF-1, GHR and GHBP, along with increases in GH and IGFBP-1. This study evaluated the influence of glycemic control in the linear growth of T1DM patients treated at Universitary Hospital João de Barros Barreto and compared the growth of these patients with the WHO`s reference. For that, a retrospective cohort study was made using data from medical records at the period between 5 and 19years old from 78 patients (40 females/ 38 males) following the criteria of age at the diagnosis £ 15 years old (females) and £ 17 years old (males). They were at diagnosis 8,6 years old, the duration of the disease was de15,4 years, glycated hemoglobin (HbA1C) 10,5 %. Among them, 58 patients (28 females/ 28 males) were achieved the final height (FH). The female’s FH was 156,2cm (Z score -1,11SDS) and the male’s FH was 166cm (Z score -1,45SDS). Only 19% were above the OMS`s media. But 26% had short stature. 9% were at Z≤ -3SDS. HbA1C ≥ 9,5% was related with worse FH. Each 1% of elevation in HbA1C was associated with a reduction of 2,23cm on FH, and 26% of FH variability were influenced by HbA1C level. The ones with HbA1C ³ 9% had significant stature loss compared to TH. In conclusion, the T1DM patients evaluated were shorter than the media of WHO`s charts, however the majority did not have short stature. HbA1C levels were negatively associated with stature loss compared to TH and final heigh. There was no correlation between FH and weight, insulin total dose, gender and diabetes duration.