EFFECT OF GLYCEMIC CONTROL ON THE GROWTH VELOCITY AND SEVERAL METABOLIC PARAMETERS OF CONVENTIONALLY TREATED CHILDREN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

To determine the effect of glycemic control on the growth velocity and several metabolic parameters of children with insulin-dependent diabe tes mellitus (IDDM)), 79 patients with IDDM, 45 females and 34 males w ith a mean chronological age of 8.4 +/- 3.0 years were followed over a 5-year period starting at the onset of diabetes. Glycemic control was assessed by measuring total glycosylated hemoglobin; children were di vided into better controlled, GHb < 9%, 30 children (Group A) and wors e controlled, GHb greater than or equal to 9%, 49 patients (Group B). Growth velocity was significantly lower, in the five years of follow u p, in the worse controlled patients when compared to the better contro lled subjects (4.8 +/- 1.6 vs 6.7 +/- 2.2 cm/yr after the first year a nd 5.0 +/- 2.0 VS 6.5 +/- 1.8 cm/yr after the fifth year, in group B a nd group A, respectively). Higher cholesterol (185.3 +/- 33.7 vs 158.8 +/- 39.5 mg/dl) and triglyceride levels (85.9 +/- 43.5 vs 71.0 +/- 37 .4 mg/dl) were apparent in the worse controlled patients, when compare d to the better controlled children. Insulin dose was not significantl y different in the two groups (0.76 +/- 0.3 vs 0.84 +/- 0.4 U/kg/day i n the 1st year and 0.9 +/- 0.3 vs 0.92 +/- 0.4 U/kg/day in the 5th yea r, in group B and A respectively). Although both groups received the s ame initial and long term training by our pediatric diabetes team, mor e frequent blood glucose monitoring, better record keeping and rotatio n of injection sites and more clinic visits were clearly noted in the better controlled group. Ketoacidotic episodes were more common in the worse controlled patients, while better controlled children had a hig her number of hypoglycemic episodes. In conclusion, we have found poor glycemic control, as reflected by higher glycosylated hemoglobin leve ls, to affect the growth velocity and several metabolic parameters of children with diabetes followed for a five-year period. Other factors besides insulin dose and initial and subsequent diabetic education see m to play a role in their glycemic control.