Ximena Gaete

Ponderal gain, waist‐to‐hip ratio, and pubertal development in girls with type‐1 diabetes mellitus

Abstract:  Objectives:  We assessed pubertal development, height, weight, and waist‐to‐hip ratio (WHR), an index of central adiposity during puberty, in girls with type‐1 diabetes mellitus (T1DM), compared to a contemporary control group.

Edad de la menarquia y su relación con el nivel socioeconómico e índice de masa corporal

BACKGROUND A decline in the age of menarche was observed from early 1900s to the 1970s. However, it is not known if a further decline occurred thereafter. AIM To evaluate the age of menarche in girls from Santiago, Chile and its relationship with body mass index (BMI) and socioeconomic status. MATERIAL AND METHODS We studied 1302 healthy girls aged 7 to 19 years. Age of menarche was evaluated through a questionnaire to the patient and her parents. Kaplan-Meier curves were used to determine age of menarche and Cox regression analysis was employed to evaluate the effect of the type of school and BMI on the age of menarche. RESULTS The mean age at menarche was 12.7+/-0.04 years. Girls from public and private schools had their period at 12.5+/-0.1 and 13.05+/-0.05 years respectively. A negative correlation between z scores for BMI and age of menarche was observed (r-0.3: p =0.001). Girls whose menarche occurred before 11.5 years had higher z scores for BMI and a larger proportion were overweight, compared to girls who had menarche later. Cox regression analysis showed that after adjustment for BMI, age of menarche was similar in both types of schools. CONCLUSIONS Age of menarche is occurring three months earlier in girls from public schools, which is associated with higher z scores for BMI. Type of school, a marker of socio-economic status in Chile, affects timing of menarche due to differences in body mass index.

Menstrual cycle irregularities and their relationship with HbA1c and insulin dose in adolescents with type 1 diabetes mellitus

OBJECTIVE To evaluate the prevalence and risk factors of menstrual cycle irregularities in adolescents with type 1 diabetes mellitus. DESIGN Prospective diary of menstrual cycle. SETTING Pediatric diabetes clinics and nearby schools. PATIENT(S) Adolescents with type 1 diabetes mellitus treated with multiple daily insulin doses (n = 56) and 56 healthy adolescents. MAIN OUTCOME MEASURE(S) Duration and variability of menstrual cycle. RESULT(S) Duration of the menstrual cycle was 48 ± 39 and 32 ± 7 days in girls with type 1 diabetes mellitus and controls, respectively. Oligomenorrhea (58.9% vs. 19.6%) and amenorrhea (10.7% vs. 1.8%) were more prevalent in girls with type 1 diabetes mellitus than in controls. Oligomenorrhea was observed in 53.3% of the girls with type 1 diabetes mellitus with optimal metabolic control. Girls with an HbA1c level of 7.6% to 8.9% exhibited increased cycle duration, menstrual cycle variability, and prevalence of oligomenorrhea compared with controls. Regression analysis showed that, for each point of increase in HbA1c, the menstrual cycle duration increased by 5.1 days. Cycle variability was associated with a higher daily insulin dose. CONCLUSION(S) Despite optimal metabolic control, a higher prevalence of oligomenorrhea was observed in girls with type 1 diabetes mellitus compared with controls. This is the first report to describe the high variability of the menstrual cycle in type 1 diabetes mellitus. HbA1c and insulin dose are important factors related to menstrual irregularities in type 1 diabetes mellitus.

Cronología del desarrollo puberal en niñas escolares de Santiago: relación con nivel socio-económico e índice de masa corporal

Background: Recent studies in the United States have demonstrated that a significant proportion of girls show thelarche before the age of eight years. Nutritional status, geographic influences and racial factors are known to affect the timing of puberty. Aim: To evaluate the age of onset of puberty, development of secondary sexual characteristics and menarche in Chilean girls, and its relation to obesity and socioeconomic status. Material and methods: Healthy girls attending elementary school, from first to ninth grade in Santiago, Chile, were studied. A pediatric endocrinologist evaluated pubertal development using Tanner classification. Breast development was assessed by inspection and breast palpation. Average age of onset of pubertal events was determined by probit analysis. Results: A total of 758 girls, aged 5.8 to 16.1 years, were recruited. Obesity, defined as a BMI greater than 90th percentile, was found in 24.4%. The age of menarche was 12.7 years, the onset of Tanner stage 2 breast development and pubic hair was at 8.9 and 10.4 years, respectively. Sixteen percent of girls aged 7 to 7,9 years, had thelarche. Upper class girls showed a later onset of breast Tanner stage 4 stage than low-middle class girls. Obesity was not found in logistic regression analysis to be a significant predictive factor in the onset of puberty. Conclusions: The age of menarche has not changed in the last thirty years, but an earlier onset of thelarche has occurred. The high frequency of thelarche between 7 and 8 years suggests that the normal age of breast development should be revised (Rev Med Chile 2004; 132: 801-8). (Key Words: Body mass index; Menarche; Puberty; Sex maturation)

Adelanto de la pubertad en Chile y el mundo

La menarquia se ha adelantado progresivamente desde mediados del siglo XIX, hecho conocido como tendencia secular de la menarquia, fenomeno que parece ser una caracteristica evolutiva del ser humano en relacion al mejoramiento de las condiciones de vida. Sin embargo, durante los ultimos treinta anos la edad de la menarquia se ha mantenido estable. A diferencia de la menarquia, la telarquia esta ocurriendo a una edad mas precoz que hace algunas decadas y es frecuente encontrar casos de telarquia aislada en ninas menores de 8 anos. En el varon, en cambio, no hay evidencias de que su desarrollo este ocurriendo mas tempranamente. En el presente articulo, se discute la etiologia del adelanto puberal y los factores que se deben tomar en cuenta en las pacientes para decidir un eventual estudio y tratamiento

Resultados de un programa multidisciplinario de tratamiento intensificado de la Diabetes Mellitus tipo 1 (DM1) en un Hospital Público

BACKGROUND During the last decade, the importance of glycemic control in the prevention of the microvascular complications of type 1 Diabetes Mellitus (DM1) was clearly demonstrated. AIM To evaluate the metabolic and anthropometric results of a multidisciplinary intensified treatment program of DMI in children and adolescents. PATIENTS AND METHODS Report of 54 patients treated during 2001. The intensified treatment consisted of: multiple daily doses of insulin, frequent glycemic control, nutritional, psychological and educational support, and permanent availability of a diabetes nurse for telephonic support. RESULTS Thirty one patients were female, their mean age was 10.4 +/- 0.5 years old and 52% were experiencing puberty. Fifty three percent of the patients used 3 insulin doses per day, 95% changed rapid insulin dose based on glucose levels and 18% considered carbohydrates in their rapid insulin dosing. Mean glycosilated hemoglobin was 8.18 +/- 0.23% without differences by sex or pubertal status. Sex, pubertal stage and the number of insulin doses did not contribute to glycosilated hemoglobin changes. There were no differences in weight or BMI, but there was a decrease in height Z score from the admission to the program until the last control (0.1 +/- 0.1 vs--0.3 +/- 0.1 DS; p < 0.01). CONCLUSIONS A modified intensified modality of DM1 therapy for pediatric patients in a public hospital in Chile is feasible, achieving similar metabolic control, compared to international large centers.

Diabetes Mellitus tipo 1 (DM1) en niños menores de 5 años: Características al debut vs otros grupos etarios en Chile

Introduccion: En los ultimos anos, se ha visto un aumento en la incidencia de DM1 en ninos. Objetivo: Determinar frecuencia y caracteristicas clinicas y de laboratorio al debut de DM1 en ninos chilenos menores de 5 anos, comparado con los de mayor edad. Pacientes y Metodos: Se estudiaron los datos clinicos y de laboratorio de pacientes que debutaron entre 1998-2003 en cuatro centros de Santiago. Se clasificaron en 3 grupos etarios (G): 0-4 (GI), 5-9 (GII) y 10-14 anos (GIII) y se compararon segun los parametros descritos. Resultados: Un 19,7% de los pacientes eran menores de 5 anos; GI (n = 27), seguido de aquellos pertenecientes a GII (43,8%; n = 60) y GIII (36,5%; n = 50). El periodo de sintomas previo al diagnostico fue mas corto en GI; 18,4 ± 23,7 vs 26,4 ± 27,4 y 40,1 ± 60 dias (p 0,05). Conclusiones: Un porcentaje importante de las DM1 se inicia en ninos < 5 anos. Este grupo presenta un cuadro mas grave, con mayor acidosis, menores niveles de HbA1c y periodo previo de sintomas, por lo que debe existir alerta para el diagnostico en este grupo etario

Testicular function during adolescence in boys with type 1 diabetes mellitus (T1D): absence of hypogonadism and differences in endocrine profile at the beginning and end of puberty

Conflicting results regarding testicular function in adults with type 1 diabetes (T1D) have been reported, but little is known about Leydig and Sertoli cell function during puberty in boys treated with multiple daily insulin doses. Our aim was to assess testicular function in boys with T1D.

Cortisol hyporesponsiveness to the low dose ACTH test is a frequent finding in a pediatric population with type 1 diabetes mellitus

In adults with type 1 diabetes mellitus (DM1), a 25% of risk of hypocortisolism has been found through a low dose ACTH test with negative antibodies suggesting other causes of hypothalamic–pituitary–adrenal axis dysfunction.

La pubertad en niños chilenos muestra un adelantamiento en el inicio del crecimiento testicular

BACKGROUND A secular trend towards a younger age of puberty onset has been reported in Chilean girls. AIM To evaluate the age of onset of puberty and prevalence of early puberty in Chilean boys. MATERIAL AND METHODS A pediatric endocrinologist examined 319 children attending schools in central Santiago. Pubertal development was assessed by testicular volume (TV) and genital inspection (GI) using Tanner graduation. Precocious and early puberty development was diagnosed if TV ≥ 4 ml or GI > stage 2 occurred in boys younger than 9 years and at 9-10 years of age, respectively. RESULTS Pubertal onset occurred at 10.2 ± 1.5 years according to TV and at 11.1 ± 1.6 years according to GI (p < 0.01). Before the age of nine, 15.2% of children had a VT ≥ 4 ml, 3% had genital changes in GI and only 3% had both changes simultaneously. Early puberty was observed in 23.8% of children according to TV and 9.5% according to GI. However, no child of less than 11 years old had a TV ≥ 4 ml, genital changes and pubic hair simultaneously. Late pubertal stages occurred at the same age according to both criteria used. Body mass index z score was not associated with the age of pubertal onset. CONCLUSIONS Testicular enlargement occurs one year earlier than changes in genitalia according to inspection. Testicular growth, but not late stages of puberty, are occurring one year earlier than previously reported in Chile 10 years ago.Background: A secular trend towards a younger age of puberty onset has been reported in Chilean girls. Aim: To evaluate the age of onset of puberty and prevalence of early puberty in Chilean boys. Material and methods: A pediatric endocrinologist examined 319 children attending schools in central Santiago. Pubertal development was assessed by testicular volume (TV) and genital inspection (GI) using Tanner graduation. Precocious and early puberty development was diagnosed if TV ?4 ml or GI >stage 2 occurred in boys younger than 9 years and at 9-10 years of age, respectively. Results: Pubertal onset occurred at 10.2± 1.5 years according to TV and at 11.1±1.6 years according to GI (p < 0.01). Before the age of nine, 15.2% of children had a VT ? 4 ml, 3% had genital changes in GI and only 3% had both changes simultaneously. Early puberty was observed in 23.8% of children according to TV and 9.5% according to GI. However, no child of less than 11 years old had a TV ? 4 ml, genital changes and pubic hair simultaneously. Late pubertal stages occurred at the same age according to both criteria used. Body mass index z score was not associated with the age of pubertal onset. Conclusions: Testicular enlargement occurs one year earlier than changes in genitalia according to inspection. Testicular growth, but not late stages of puberty, are occurring one year earlier than previously reported in Chile 10 years ago.