The contribution of glycemic control to impaired growth during puberty in young people with type 1 diabetes and microalbuminuria

Background In adults with type 1 diabetes (T1D), short stature has been associated with risk for cardiovascular disease and nephropathy. However, there are no available data on the potential relationship between growth patterns during puberty and the development of vascular complications. Our aim was to assess whether pubertal growth is impaired in young people with T1D who develop microalbuminuria (MA). Methods Repeated height measurements performed during adolescence were available for 206 young people (107 boys) with T1D followed in the Oxford Regional Prospective Study. Longitudinal data on albumin-creatinine ratios and hemoglobin A1c (HbA1c) were also collected from the study participants. Height standard deviations score (SDS) was compared between subjects with (MA+; n=66) and without MA (MA-; n=140). Results In the group as a whole, mean [95% CI] height SDS progressively declined during puberty, from 0.145 [0.015; 0.274] to -0.003 [-0.145; 0.138], p<0.001. However, the decline in height SDS was significantly different between the MA+ and MA- groups (p=0.023), with a mean difference in final height of 4.29 [1.87; 6.72] cm, p=0.001. Final height was inversely associated with MA (HR [95%CI]: 0.942 [0.908; 0.979], p=0.002), although this association was no longer significant after adjusting for HbA1c, which was higher in the MA+ group. Conclusion In this study, we found a significant impairment in growth during puberty in young people with T1D, particularly in those developing MA. Poor glycemic control as well as other genetic or environmental factors could explain these associations.