الفهرس 
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Abstract
SUMMARY
ype 1 diabetes mellitus (T1DM) is one of the most
common chronic metabolic disorders in children and
adolescents and its incidence is increasing worldwide. It is
considered a factor that potentially affects the onset of male and
female puberty and pubertal development and maturity. The
earlier its onset, the longer and more severe the disease, and the
greater the repercussion on growth and pubertal development.
Puberty is characterized by important physiological and
hormonal changes. In type 1 diabetes, abnormalities in the
growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis
play an important role. Reduced IGF-1 levels in patients with
poor glucose control may contribute to complications such as
poor linear growth and low bone mineral content given that
IGF-1 is a major anabolic regulator of bone growth and
metabolism.
The aim of the present study was to assess the
anthropometric measures and pubertal growth of children and
Adolescents with T1DM regularly attending Pediatric and
Adolescents Diabetes Clinic, Ain Shams University and detect
risk determinants affecting these measures and their link to
glycemic control.
T
Summary
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This was Cross-Sectional Observational study, conducted
on 200 patients at Pediatric and adolescent diabetology
outpatient Clinic, Children’s Hospital, Ain Shams University
during a period of Six months. All patients with delayed growth
were subjected to: IGF 1 for detection of growth hormone
affection, Anti-tissue transglutaminase IgG and IgA for
detection of Celiac disease, radiological evaluation by plain x
ray on left hand and wrist & Bone age were done. Patients with
delayed puberty were evaluated by detection of sex hormones
(LH, FSH and testosterone) basal and after stimulation.
The main results of the study revealed that:
In our study we found that the prevalence of short stature
among our studied cases was (12.5%), females compared to
males (60 % versus 40% respectively).
In our study we found that the prevalence of delayed puberty
was (7.5%), females compared to males (86.7 % versus 13.3
% respectively).
Short stature diabetic patients have significantly lower final
Tanner score compared to those with normal stature
patients.
Diabetic patients with short stature have significantly higher
HbA1C, FT4 and Albumin/creatinine ratio compared to
those with normal stature diabetic patients. Meanwhile
diabetic patients with short stature have lower Hb and MCV
compared to those with normal stature diabetic patients.
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124
There is no significant difference between diabetic patients
with short stature and those with normal stature regarding
their basal and stimulated gonadotropin levels (FSH&LH),
sex hormone levels (Testosterone & Estradiol).
Patients with short stature have significantly lower IGF-1,
IGF-1 SD and lower (delayed) bone age compared to those
patients with normal stature. Patients with short stature have
significantly higher incidences of cases with abnormal IGF-
1 (72%) and significantly lower incidence of cases with
normal IGF-1 (28%).
Diabetic patients with non-familial short stature have
significantly earlier age of onset of diabetes, earlier age at
diagnosis and longer duration of diabetes compared to those
diabetic patients with normal stature and familial short
stature.
In diabetic patients with non-familial short the highest
significant order of birth was the 3rd 6 (50.0%), while in
diabetic patients with normal and familial short stature the
highest significant order of birth was the 2nd 58 (30.9%),
Diabetic patients with non-familial short stature have
significantly lower Weight (kg), Wt. SDS, less Height (cm),
Ht. SDS, BMI SDS, Waist circumference, WC SDS, Hip
circumference and HipC SDS compared to those diabetic
patients with normal stature and familial short stature.
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125
Diabetic patients with non-familial short stature have
significantly higher HbA1C, Create, fasting cholesterol, TG,
and Albumin/creatinine ratio compared to those with normal
stature and familial short stature. Meanwhile diabetic
patients with non-familial short stature have lower HB
compared to those with normal stature and non-familial
short stature.
There is no significantly difference between diabetic
patients with non-familial short stature and with those
normal stature and familial short stature regarding their IGF-
1, IGF-1 SD and Bone age (yrs.).
Diabetic patients with delayed puberty have significantly
higher BMI SDS and W/Hip SDS compared to those
patients with normal puberty. Meanwhile patients with
delayed puberty have significantly lower Wt SDS, Ht. SDS,
Waist circumference, Waist circumference SDS, Hip
circumference and Hip circumference SDS compared to
those diabetic patients with normal puberty.
Diabetic patients with delayed puberty have significantly
higher bone age (yrs.) compared to those diabetic patients
with normal puberty.
Prevalence of GDM in diabetic patients with normal IGF-1
(71.4%) and in diabetic patients with abnormal IGF-1
(25.0%). There was significantly increase in incidence of
GDM among diabetic patients with normal IGF-1.
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126
Diabetic patients with normal IGF-1 have significantly
higher Ht. SDS compared to those diabetic patients with
abnormal IGF-1.
Diabetic patients with normal IGF-1 have significantly
lower WBC compared to those diabetic patients with
abnormal IGF-1.
Diabetic patients with normal IGF-1 have significantly
higher incidence of Stimulated LH levels compared to those
diabetic patients with abnormal IGF-1.
Diabetic patients with delayed puberty and short stature
have significantly higher abnormal IGF-1 compared to other
two groups.
there was significant positive correlation between IGF-1 and
duration of diabetes (yrs.), Weight (kg), Height (cm), Ht.
SDS, Waist circumference, Waist circumference SDS, Hip
circumference, W/Hip SDS, Penile length (cm), Rt testicular
volume (ml), Lt testicular volume (ml) and Final Tanner
score.
The best cut off point of IGF-1 SDS to detect Short stature
was found ≤ -1.2 with sensitivity of 76%, specificity of
100.0%, PPV of 100.0%, NPV of 45.5% and total accuracy
of 82.8%.
The univariate logistic regression analysis shows that all the
previous factors were significantly associated with short
stature. Meanwhile the multivariate logistic regression
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127
analysis shows that the most significantly associated factors
with short stature were Age at diagnosis, HbA1C >8.2 and
Albumin/creatinine ratio >8.
The univariate logistic regression analysis shows that all the
previous factors were significantly associated with delayed
puberty. Meanwhile the multivariate logistic regression
analysis shows that the most significantly associated factors
with delayed puberty were Ht. SDS <=-0.44, W/Hip SDS
>1.92 and Breast volume.
Based on our results we recommend further studies on larger
patients and longer period of follow up to emphasize our
conclusion.