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No pubertal delay observed in boys with type 1 diabetes
Boys with type 1 diabetes tend to begin puberty at a similar or even earlier age than healthy boys, a finding that suggests optimization of insulin is improving metabolic control and pubertal timing, according to findings published in Pediatric Diabetes.
Previous research has described an advancement in the age of puberty initiation in healthy boys; however, it remains unclear whether boys with type 1 diabetes have experienced a similar change in pubertal timing, Ethel Codner, MD, professor of pediatric endocrinology and diabetology at the Institute of Maternal and Child Research at the University of Chile School of Medicine, and colleagues wrote in the study background.
“Previous studies that have evaluated puberty in boys with [type 1 diabetes] have not included a control group, have used historical controls or were performed years before the current insulin treatment was the standard therapy,” Codner and colleagues wrote. “Thus, it is currently unclear if the age of pubertal events is comparable in children with [type 1 diabetes] and healthy males.”
In a cross-sectional study, researchers analyzed data from 148 boys aged 7 to 19 years with type 1 diabetes recruited from three area hospitals in Santiago, Chile (mean age, 13 years), as well as 388 healthy boys recruited from four schools in the same city (mean age, 13 years). A pediatric endocrinologist evaluated pubertal development between 2011 and 2015. Puberty was considered present when testicular volume was at least 4 mL or Tanner stage 2 or higher was reached. Precocious puberty was defined as testicular volume of at least 4 mL in boys younger than 9 years. Researchers used logistic binary regression analysis to assess the effect of BMI standard deviation, mean HbA1c level, duration of diabetes and daily insulin dose on the probability of showing early puberty or having attained the final stages of pubertal development.
Researchers found that boys with type 1 diabetes at genital Tanner stage 2 were younger than healthy controls (P = .005), as were boys with type 1 diabetes at genital Tanner stages 4 and 5 (P = .003 and .015, respectively). Boys with diabetes at Tanner stage 3 were on average 6 months younger vs. controls; however, the difference did not rise to statistical significance, according to researchers.
There were no between-group differences in age of pubic hair Tanner stage development, and researchers did not observe any cases of pubertal delay in the type 1 diabetes group.
The researchers found that the only factor associated with the probability of having a younger age of pubertal initiation was duration of type 1 diabetes (P < .01). A longer disease duration increased the odds of both testicular volume of at least 4 mL (OR = 1.35; 95% CI, 1.08-1.7) and reaching genital Tanner stage 2 (OR = 1.36; 95% CI, 1.1-1.7). Researchers did not observe associations between HbA1c, insulin dose or BMI z score and attaining initial stages of puberty.
Additionally, researchers observed that adolescents with type 1 diabetes and healthy boys had a similar height standard deviation score at the onset of puberty; however, boys with type 1 diabetes were shorter at the end of pubertal development.
“These findings suggest pubertal delay and hypogonadism are not a problem in adolescent boys with [type 1 diabetes] treated with multiple insulin doses or having the proper degree of metabolic control present in many places worldwide,” the researchers wrote. “Our data showing a normal age of pubertal development in [type 1 diabetes] differ from previous reports that showed a mild delay of puberty initiation in boys with [type 1 diabetes].” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.